New York Assembly Bill A06842 Latest Draft

   
  STATE OF NEW YORK ________________________________________________________________________ 6842 2023-2024 Regular Sessions  IN ASSEMBLY May 8, 2023 ___________ Introduced by M. of A. KELLES -- read once and referred 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. LBD09970-01-3