Senate Bill S5649

2023-2024 Legislative Session

Relates to preclaim review for participating providers of medical assistance program services and items

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Current Bill Status - Stricken

  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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2023-S5649 (ACTIVE) - Details

Law Section:
Social Services Law
Laws Affected:
Amd §363-e, Soc Serv L

2023-S5649 (ACTIVE) - Summary

Requires a verification organization to declare each service or item to be verified or unverified within thirty days of receiving all required supporting documentation from a participating provider.

2023-S5649 (ACTIVE) - Sponsor Memo

2023-S5649 (ACTIVE) - Bill Text download pdf 

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5649
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                              March 10, 2023
                                ___________
 
 Introduced  by Sen. HARCKHAM -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the social services law, in relation to preclaim  review
   for participating providers of medical assistance program services and
   items

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 363-e of the  social  services  law,  as  added  by
 section  64  of  part  H  of chapter 59 of the laws of 2011, the opening
 paragraph as amended by section 20 of part C of chapter 60 of  the  laws
 of 2014, is amended to read as follows:
   §  363-e.  Preclaim  review  for  participating  providers  of medical
 assistance program services and items. The department of health and  the
 office  of the Medicaid inspector general shall jointly develop require-
 ments for preclaim review. Every service  or  item  within  a  claim  or
 encounter  submitted  by  a participating provider shall be reviewed and
 verified by a verification organization prior to submission of  a  claim
 or  encounter  to the department of health or to a managed care provider
 as defined in paragraph (b) of subdivision one of section three  hundred
 sixty-four-j  of this title. The verification organization shall declare
 each service or item to be verified or unverified WITHIN THIRTY DAYS  OF
 RECEIVING  ALL  REQUIRED  SUPPORTING  DOCUMENTATION FROM A PARTICIPATING
 PROVIDER. Each participating provider shall receive and maintain reports
 from the verification organization which shall contain data on:
   1. verified services or items, including whether a service appeared on
 a conflict or exception report before verification and how that conflict
 or exception was resolved; and
   2. services or items that were not verified,  including  conflict  and
 exception report data for these services.
   §  2.  This  act shall take effect on the thirtieth day after it shall
 have become a law.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD09970-01-3

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