Reminder: Disenrollment Rules and Recovery Rules for Mainstream Medicaid Managed Care, Health and Recovery Plans, and Special Needs Plans
AI Summary
New York State Medicaid has updated disenrollment and recovery rules for managed care plans, emphasizing that the state retains the right to recover capitation payments even without proper disenrollment notices. Additionally, new obstetric billing requirements take effect for prenatal care starting June 1, 2026, requiring E/M codes with TH modifiers and specific diagnostic codes.
Action Required
By June 1, 2026: Billing team must update obstetric billing procedures for new prenatal care cases. Use E/M CPT codes with TH modifier, pregnancy-related O or Z ICD-10 diagnostic codes for all prenatal visits, and include Category II CPT code 0500F for initial prenatal visits. Update billing software rules and encounter forms. For existing prenatal care established before June 1, 2026, continue current billing guidance through December 31, 2026.
Plan Types
Medicaid
States
NY
Specialties
ob-gyn, family-medicine