Bill Text: NY S04439 | 2023-2024 | General Assembly | Introduced

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Bill Title: Requires a verification organization to declare each service or item to be verified or unverified within thirty days of receiving all required supporting documentation from a participating provider.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-01-03 - REFERRED TO HEALTH [S04439 Detail]

Download: New_York-2023-S04439-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4439

                               2023-2024 Regular Sessions

                    IN SENATE

                                    February 8, 2023
                                       ___________

        Introduced by Sen. FERNANDEZ -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health

        AN  ACT to amend the social services law, in relation to preclaim review
          for participating providers of medical assistance program services and
          items

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Section  363-e  of  the  social services law, as added by
     2  section 64 of part H of chapter 59 of the  laws  of  2011,  the  opening
     3  paragraph  as  amended by section 20 of part C of chapter 60 of the laws
     4  of 2014, is amended to read as follows:
     5    § 363-e.  Preclaim  review  for  participating  providers  of  medical
     6  assistance  program services and items. The department of health and the
     7  office of the Medicaid inspector general shall jointly develop  require-
     8  ments  for  preclaim  review.  Every  service  or item within a claim or
     9  encounter submitted by a participating provider shall  be  reviewed  and
    10  verified  by  a verification organization prior to submission of a claim
    11  or encounter to the department of health or to a managed  care  provider
    12  as  defined in paragraph (b) of subdivision one of section three hundred
    13  sixty-four-j of this title. The verification organization shall  declare
    14  each  service or item to be verified or unverified within thirty days of
    15  receiving all required supporting  documentation  from  a  participating
    16  provider. Each participating provider shall receive and maintain reports
    17  from the verification organization which shall contain data on:
    18    1. verified services or items, including whether a service appeared on
    19  a conflict or exception report before verification and how that conflict
    20  or exception was resolved; and
    21    2.  services  or  items that were not verified, including conflict and
    22  exception report data for these services.
    23    § 2. This act shall take effect on the thirtieth day  after  it  shall
    24  have become a law.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD08931-01-3