NYRx Cost Optimization Program Update Click to Enlarge NYRx’s September 10 Cost Optimization update and current Preferred Drug List (PDL) are available. Additional PDL and Brand Less Than Generic (BLTG) changes are scheduled for October 22. Beginning in November, prior authorization requirements for physician-administered drugs
NYRx Cost Optimization Program Update Click to Enlarge The New York State Medicaid Pharmacy Program (NYRx) has expanded its Cost Optimization Program, effective July 16, 2026, by adding additional high-cost drug formulations and dosages that are significantly more expensive than therapeutically equivalent alternatives. The initiative
NYRx Updates: Resources Available for Review Click to Enlarge MSSNY recognizes that keeping pace with Medicaid pharmacy policy changes can be challenging amid growing administrative responsibilities. We encourage physicians, practice managers, billing teams, and clinical staff to review the available NYRx resources and assess whether
Attention Physicians: Are You Being Underpaid by Optum? Click to Enlarge If you are billing CPT code 95165 and are being underpaid by Optum, please email our Physician Payment and Practice Division, as we may be able to help.
Payment & Practice: Turning Complex Payer Challenges Into $38 Million Recovered Revenue Click to Enlarge Key Point: MSSNY’s Payment and Practice team has recovered $38 million since 2021, including $10.8 million so far in 2026, directly returning revenue to physician practices.Why It Matters: Payer denials, recoupments, and
Important Changes Coming to National Government Services Click to Enlarge A message from National Government Services: National Government Services will begin operating as Wellpoint Federal on April 1, 2026. New name, same trusted partner For decades, we have empowered federal healthcare agencies to improve lives
Introducing the IDR Gateway Click to Enlarge In the latter half of 2026, the Federal Independent Dispute Resolution (IDR) process will transition from single-use web forms to the new IDR Gateway, which will provide a secure, centralized platform that parties can use to manage disputes.
Workers’ Comp Policy Needs Physicians Click to Enlarge NY Workers’ Comp treatment guidelines shape care approvals, documentation, and reimbursement. MSSNY seeks physicians to help update these policies and ensure they reflect real clinical practice. Your voice matters. Learn More
MSSNY Helps Physicians Recover $5.5M in 2026 Click to Enlarge Key Outcome: MSSNY’s Physician Payment and Practice Division has recovered over $5.5 million for MSSNY members in 2026 through claims resolution and payer advocacy. Why it Matters: Payment delays, denials, and takebacks create major financial
Physicians Needed for NY Workers’ Compensation Advisory Committee Click to Enlarge Key Point:The New York State Workers’ Compensation Board is reconvening its Medical Advisory Committee (MAC) to update 16 Medical Treatment Guidelines and the Drug Formulary.Why It Matters for MSSNY Physicians:These guidelines directly affect treatment decisions, reimbursement, and
