Changes to NYRx Drug Formulary Effective August 1, 2024 Click to Enlarge The New York State Medicaid Program has implemented significant updates to the NYRx Preferred Drug List (PDL) effective August 1, 2024, following the May 16, 2024, DUR Board meeting. These changes include new additions and
NYRx Pharmacy Rejections: Key Updates for Physicians Click to Enlarge Attention all healthcare providers: Important changes have been made regarding NYRx pharmacy claim rejections. It's crucial to understand the reasons behind claim denials and how to resolve them effectively. Prior Authorization Requirement: Only one type of
Extension Granted for Federal IDR Process Due to CrowdStrike Windows Outage Click to Enlarge On 7/19/2024, the Departments announced that they will grant disputing parties impacted by the CrowdStrike Windows outage a one business day extension for any activity in the federal Independent Dispute Resolution (IDR)
Important Update: CMS Policy Change on Cosmetic and Reconstructive Surgery Claims Click to Enlarge Attention Surgeons: A recent policy change by CMS in August 2023 now mandates the inclusion of a secondary diagnosis code alongside the primary for cosmetic and reconstructive surgery claims. Without this secondary
2025 Medicare Physician Fee Schedule Proposed Rule Click to Enlarge The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for the Calendar Year 2025 Medicare Physician Fee Schedule. Key highlights include: Payment Adjustments: Proposed changes in payment rates for various medical services.
AMA Summary of 2025 Medicare Physician Payment Schedule Click to Enlarge The American Medical Association (AMA) released its summary of the 2025 Medicare Physician Payment Schedule proposed rule, along with the AMA’s analyses of CMS’ impact assumptions for proposed G-codes, the advanced primary care management services,
NYRx Information for Interns and Residents Click to Enlarge NYRx, the Medicaid Pharmacy Program and the NYRx Education and Outreach team has worked to compile information in the linked document, NYRx, the Medicaid Pharmacy Program Information for Medical Residents, to share with medical interns and residents to help
Extension for Open Negotiations Impacted by Change Healthcare Cybersecurity Incident The Departments of Health and Human Services, Labor, and the Treasury (collectively, the Departments) announced a 120-calendar-day exception period for disputing parties impacted by the recent Change Healthcare cybersecurity incident to initiate open negotiation for impacted items or services, beginning 6/14/2024 and ending 10/12/2024. Following
CMS Preparing to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack The Centers for Medicare & Medicaid Services (CMS) announced that payments under the Accelerated and Advance Payment (AAP) Program for the Change Healthcare/Optum Payment Disruption (CHOPD) will conclude on July 12, 2024. Launched in early March, the CHOPD payments were
New Process for Batched IDR On May 1, 2024, a new process was released for resubmitting Independent Dispute Resolution (IDR) disputes that were originally improperly batched or bundled. This new resubmission process will streamline Federal IDR operations and enhance the user experience. Resubmission requests received on or before April 30, 2024 If a certified IDR entity
