New York State Patient-Centered Medical Home Program Click to Enlarge Primary care providers who missed the March 31, 2025, deadline can still submit an attestation for the New York State Patient-Centered Medical Home Provider (NYS PCMH), Medicaid Managed Care (MMC) and Child Health Plus (CHPlus)
NYRx Education & Outreach: February Updates and Key Developments Click to Enlarge The NYRx Education & Outreach (E&O) team has released its latest Month in Review newsletter, highlighting key updates in pharmacy services, Medicaid regulations, and public health initiatives. This edition covers significant changes, including
MSSNY Advocacy Helps Secure Medicare Reimbursement for Allergen Extract Dilutions Click to Enlarge Successful collaboration ensures better patient access and fair physician reimbursementThe American College of Allergy, Asthma, and Immunology (ACAAI) has announced a significant reimbursement victory for allergists and healthcare professionals. Below is their official press
Are You Having Issues Getting Medicare Advantage Telehealth Services Covered? Click to Enlarge MSSNY has fought for state and federal laws that have helped to ensure that NYS insurance and Medicare plans cover telehealth provided services at the same rate as in-person services and is advocating that
New York State & Federal Independent Dispute Resolution (IDR) Overview Webinar Click to Enlarge Join us for an essential webinar tailored to help you navigate the complexities of the Independent Dispute Resolution (IDR) process under the No Surprises Act (Federal) and New York’s No Surprise Law.
Navigate Telehealth’s Challenges: Jan. 22 Webinar Click to Enlarge Join Deanna Mirro-Altmann and Rafi Cheema, Esq., on January 22 from 6:30-8:00 PM for Beyond the Screen: Navigating Telehealth’s Challenges and Opportunities. Gain actionable insights to enhance your telehealth practice. Register now and face telehealth challenges together!
NYRx Formulary Update: Nucynta and Xtampza No Longer Covered Click to Enlarge Effective January 1, 2025, Collegium Pharmaceutical, the manufacturer of Nucynta®, Nucynta ER®, and Xtampza® is no longer participating in the Medicaid Drug Rebate Program and therefore these drugs will no longer be covered by NYRx.
NYRx Medicaid Pharmacy Prior Authorization Programs Update Click to Enlarge On October 25, 2024, the New York State Medicaid Drug Utilization Review Board (DURB) recommended changes to NYRx, the Medicaid pharmacy prior authorization (PA) program. The Commissioner of Health has reviewed the recommendations of the Board and has
NGS Addresses Claim Denials Related to HCPCS Code G2211 Click to Enlarge National Government Services (NGS) has reported an issue impacting Part B providers in Jurisdictions JK and J6 regarding claim denials for the HCPCS G2211 add-on code. The problem stems from a coding update on December 5,
CPT Codes for Prior Authorization: Reporting Prior Authorization–Related Activities Within E/M Services (99203, 99204, 99205, 99213, 99214, 99215, 99358, 99452, 99080) Click to Enlarge Prior authorization (PA) is an administrative process that requires physicians or other qualified health care professionals (QHPs) to obtain approval from
