Retro Bill Court Ordered Rate Codes by November 28, 2023

CHCANYS has been working with the Department of Health to obtain approval for health centers to retroactively bill court ordered rate codes (rate code 4026, 4027, 4028) back to October 1, 2016. CMS has granted that approval, and DOH is now allowing health centers 90 days to submit all court ordered claims retroactive to October 1, 2016, using delay reason code 3. These claims may be subject to an automatic denial from eMedNY, however, once the 90-day period has expired the Department of Health’s Bureau of Managed Care Reimbursement (BMCR) will request a special input which will allow these claims to pay. All retro claims must be submitted by November 28, 2023 and no extensions to the November 28th date will be given. Billing questions should be directed to the Department’s billing agent General Dynamics Information Technology Company (GDIT) at 1-800-343-9000.

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