FIPS/County Code Error Correction for HCBS Non-Risk Claims
- Announcement also available in Portable Document Format (PDF)
July 11, 2024
TO: Medicaid Managed Care Plans (MMCPs) including Mainstream and HIV Special Needs Plans
The FIPS/County Locator changes that denied MMCP non-risk claims for Children's Waiver Home and Community-Based Services, has been fixed.
Effective December 1, 2023, all non-risk claims for Children's Waiver HCBS submitted by MMCPs are required to include an appropriate FIPS/County Locator Code. An eMedNY configuration error resulted in inappropriate denials for claims including FIPS/County locator codes associated with counties other than the HCBS participant's county of fiscal responsibility. A system fix has been successfully implemented, and claims submitted with FIPS/County Locator Codes for any county associated with provider of record's designation are now permitted within the system.
Non-risk claims for Children's Waiver HCBS with dates of service on or after December 1, 2023 that were denied due to this FIPS/County Locator Code configuration error can be resubmitted to eMedNY for reprocessing. MMCPs who submitted a request to the New York State Department of Health (NYSDOH) for a special payment process of these claims should not resubmit these claims for payment in eMedNY. No further requests for special processing of these claims should be submitted to NYSDOH.
Please direct questions regarding this announcement to capacitymanagement@health.ny.gov.
