New Federal Independent Dispute Resolution (IDR) Administrative Fee and Certified IDR Entity Fee Ranges Posted The Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the Treasury (collectively, the Departments) updated the No Surprises Act website to reflect upcoming changes to the Federal Independent Dispute Resolution (IDR) certified
NYRx E&O Update Flovent® and Advair® products continue to be included in the NYRx Brand Less Than Generic Program (BLTG). Due to recent changes announced by the manufacturer including the discontinuation of Flovent® and the decreased production of Advair®, effective December 21, 2023, the NYRx Medicaid Pharmacy Program will allow for the generics to these
Do You Have Unpaid Claims from NYC Law? If you have unpaid claims from NYC Law, please contact Heather Lopez to get additional information that could assist with this issue.
NYRx Preferred Drug Quick List For NYRx, the Medicaid Pharmacy Program, prescribers should review and prescribe preferred products whenever possible. The preferred drugs generally do not require prior authorization when prescribed according to FDA labeling, unless otherwise indicated. Please refer to the NYRx Preferred Drug Quick List for a resource containing only preferred drugs. The
NYRx Preferred Drug Quick List For NYRx, the Medicaid Pharmacy Program, prescribers should review and prescribe preferred products whenever possible. The preferred drugs generally do not require prior authorization when prescribed according to FDA labeling, unless otherwise indicated. Please refer to the NYRx Preferred Drug Quick List for a resource containing only preferred drugs. The
Federal IDR Portal Reopens On December 15, the Departments reopened the Federal IDR portal to process all dispute types, including previously initiated batched disputes, new batched disputes, and new single disputes involving air ambulance services. The Departments are granting extensions of the applicable IDR deadlines for the initiation of new batched disputes and new single
Don’t Miss Out on Exclusive Access to CMS/NGS! Monthly Meeting Time Change: CMS/NGS is enhancing member access by adjusting the schedule for their monthly meetings. Starting December 12th, these meetings will now occur from 12-1 pm on every second Tuesday of the month. This change ensures our members can conveniently address their questions and concerns.
New Billing Code: Know How and When to Use It Effective January 1, 2024, significant billing changes will be introduced for physicians and healthcare providers. Learn about the implementation of edits to prevent the payment of the complexity add-on code G2211 associated with specific outpatient evaluation and management visits, notably when reported with modifier 25.
CMS/NGS Monthly Meeting Time Change CMS/NGS is enhancing member access by adjusting the schedule for their monthly meetings. Starting December 12th, these meetings will now occur from 12-1 pm on every second Tuesday of the month. This change ensures our members can conveniently address their questions and concerns. Please share this information with your office
Federal Independent Dispute Resolution Process The Departments of Health and Human Services (HHS), Labor, and the Treasury (collectively, the Departments) are offering an extension of timelines related to: responding to a certified IDR entity’s request for additional information needed to determine a dispute’s eligibility for the Federal IDR process or to make a payment determination;
