Childhood Vaccine Counseling

By December 31, 2026: (1) BILLING TEAM: Update prior authorization workflows and system rules to comply with new 7-day standard PA and 72-hour expedited PA timelines. Ensure all PA submissions include complete documentation to avoid denials due to missing information. (2) BILLING TEAM: Implement tracking system to monitor PA extension requests and the 14-day extended timeline. Document date received for all PA requests. (3) BILLING TEAM AND PROVIDERS: Enroll in ePACES and eMedNY eXchange for real-time claim submission and PA requests if not already enrolled; enrollment instructions available in eMedNY ePACES document. (4) BILLING TEAM: Update billing system to ensure proper coding for breast cancer screening services (CPT 77065, 77066, 77067, 77063) and verify these services are billed with zero patient cost-sharing per NYS Breast Cancer Screening Law. (5) PROVIDERS: Review and implement NYS Medicaid breast cancer screening guidelines for all populations, including transgender and gender-diverse individuals, ensuring orders align with nationally recognized clinical guidelines. (6) COMPLIANCE: Ensure all PA denials resulting from missed deadlines are properly documented. Communicate new timelines to all clinical and administrative staff. Failure to submit complete PA documentation within required timelines will result in automatic PA denials.