Clinic Resources
- Medicaid Claims Readjudication Update
(February 28, 2014) - Claims reprocessing for dates of service 10/1/10-12/31/11 was completed on 1/13/14. This update includes information regarding the possible need for adjusting a reprocessed claim and the OMH process of setting the pre-APG rate codes to zero, effective 10/1/10.
- 2013 CPT Code Implementation - Information below describes how the new codes will affect Medicaid fee-for-service and Medicaid managed care billing and reimbursement for services provided by OMH-licensed Article 31 mental health clinics.
- December 13, 2012 Webinar FAQs (January 2, 2013)
- Recorded Webinar from December 13, 2012
- Presentation slides (503kb)
- 2013 CPT Code Changes for OMH-Licensed Clinics (157kb) - Replacement Codes, New Codes, and Unchanged Codes
- Sample Clinic Encounter Form (June 6, 2013) - This sample form was revised to include the 2013 CPT codes. This form is not required. It was developed for clinics to use if they so choose.
- Medicaid Claims Readjudication Update for All Article 31 Mental Health Clinics (May 23, 2013)– Please read the attached notice in its entirety. It contains extremely important and time sensitive information for Article 31 clinic providers regarding the long-awaited readjudication of Medicaid fee-for-service claims with dates of service 10/1/10-12/31/11. The process will begin with eMedNY cycle #1867.
- Reimbursement for Psychotropic Medications (July 23, 2012)
- Currently, Medicaid reimburses up to the amount on the Medicare price list for the three excluded drugs, Risperdal Consta, Invega Sustenna & Zyprexa Relprevv. For these three atypicals, fee-for-service (FFS) Medicaid covers these products only as physician services and not as a pharmacy benefit. The patient may not use their FFS Medicaid Benefit card and have the prescription filled at the pharmacy to bring to the physician.
- Providers can purchase medications from a wholesaler rather than from a local vendor by utilizing the state pharmacy prime vendor state contract.
- June 2012 Clinic Ambulatory Patient Groups (APG) Payment Basics and Updates Training Materials (July 23, 2012)
- Materials from Medicaid Managed Care Plan Clinic APG training session
- Presentation Slides (May 15, 2012)
- APG Implementation Questions & Answers (May 15, 2012)
- December 2011 Clinic Trainings
- Presentation slides (December 19, 2011)
- eMedNY Ambulatory Patient Groups (APG) Billing Overview (December 19, 2011)
- Commonly used J-codes for claiming Medicaid (December 21, 2011)
- 2010 Clinic Restructuring Trainings: Materials
- Clinic Reform: The Clinical Model (September 1, 2010)
- Clinic Reform Now (September 1, 2010)
- Licensing & Staffing Transition (September 1, 2010)
- Medical Necessity, Concurrent Documentation and Medicaid Compliance (September 3, 2010)
- New York State Clinical Record Initiative (September 1, 2010)
- Standards of Care
- OMH Clinic Rates Codes
These codes must be used for all services provided on or after January 1, 2012. - Letter to the Office of Medicaid Inspector General (OMIG) - Co-signed by OMH and New York State Department of Health (DOH) to OMIG
- This letter in part temporarily waives the 90 days claims submission requirement and gives clinics 3 months from the date of federal Medicaid State Plan approval to adjust all claims and make any corrections as appropriate. The letter also requests that OMIG allow a time-limited moratorium on Article 31 clinic audits and disallowances.
- Please note: When submitting claims more than 90 days from date of service during the period the waiver is in effect, clinics must enter reason code 3 (Authorized Delays - Delays previously approved). In addition, you should keep a copy of the attached letter in your files.
- Ambulatory Restructuring Project Report (June 2009)
These codes must be used for all services provided on or after January 1, 2012.
Comments or questions about the information on this page can be directed to the Bureau of Financial Planning.