Medicaid PPS Rate for Third Party Insurance Claims

Effective January 1, 2022, the NYS Department of Health will pay the full PPS rate for all Medicaid claims when Medicaid is the secondary or tertiary payer to a third party payer (Medicare and commercial). FQHCs should no longer report  commercial insurance payments on their Medicaid FFS supplemental wrap claim submissions, and instead report them on the MCVR data to be included in their MMC rate calculations. See January 2022 Medicaid Update for complete guidance.

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