NY Medicaid
Kim Edgar
Description
Collection
Title:
NY Medicaid
Creator:
Kim Edgar
Date:
1/20/2006
Text:
Dear List,
We recently have come across a situation that Medicaid is denying several items, both prosthetics and orthotic L-codes for frequency issues. I have checked both our hard copy manual that Medicaid has issued and also on the EmedNY website and no where are there frequency limitations listed for the L-codes. NY Medicaid states they are following the NYS frequency limitations on orthotic and prosthetics. When I question where we can find that information so we can know if we need to do a prior authorization we have been told, sorry they are trying to update the website, but there is nothing in writing. They simply told us we would have to call with every code every time we had a Medicaid patient. On the codes that we have already been denied on we now have to do a prior authorization and then resubmit the claim.
My question is how can they enforce something that we have no access to as providers? Has anyone else in NY experienced this situation lately? Did you before the transition? What have you been able to do about it in your office? Does anyone have any suggestions?
Thanks in advance for your responses,
Kim Edgar,
Office Manager
P & O Assoc.
We recently have come across a situation that Medicaid is denying several items, both prosthetics and orthotic L-codes for frequency issues. I have checked both our hard copy manual that Medicaid has issued and also on the EmedNY website and no where are there frequency limitations listed for the L-codes. NY Medicaid states they are following the NYS frequency limitations on orthotic and prosthetics. When I question where we can find that information so we can know if we need to do a prior authorization we have been told, sorry they are trying to update the website, but there is nothing in writing. They simply told us we would have to call with every code every time we had a Medicaid patient. On the codes that we have already been denied on we now have to do a prior authorization and then resubmit the claim.
My question is how can they enforce something that we have no access to as providers? Has anyone else in NY experienced this situation lately? Did you before the transition? What have you been able to do about it in your office? Does anyone have any suggestions?
Thanks in advance for your responses,
Kim Edgar,
Office Manager
P & O Assoc.
Citation
Kim Edgar, “NY Medicaid,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 22, 2024, https://library.drfop.org/items/show/226025.
