New Electronic Remit Regeneration Requests on the eMedNY Website

REQUIREMENTS: By December 1, 2026: - Billing team must update all prior authorization submission processes and timelines in billing software to reflect new 7-day standard PA window and 72-hour expedited PA window for NYS Medicaid fee-for-service claims. - Update internal PA tracking system to flag denials if provider documentation is not submitted within the extended 14-day information request period. - Create workflow reminder to verify all necessary documentation is included at time of PA submission to avoid denial. - Providers and clinical staff must be trained on expedited PA conversion rules (if expedited request doesn't meet emergency criteria, it will be downgraded to standard 7-day processing). Immediate (Now): - Billing team must ensure all breast cancer screening/diagnostic codes (77065, 77066, 77067, 77063) are configured in billing software to bill NYS Medicaid with zero patient cost-sharing and no prior authorization requirement for medically necessary services. - Update claim submission templates and intake forms to identify breast cancer screening/diagnostic procedures for proper adjudication. - Educate front desk and clinical staff that breast cancer screening mammograms, ultrasounds, MRI, and biopsies require no patient financial responsibility and should be flagged as no cost-share in system. - Providers should enroll in ePACES and eMedNY eXchange to enable real-time PA submission and eligibility verification to meet new aggressive timelines. Consequences of Inaction: - Claims with prior authorization requests submitted after 7 days will be denied for standard requests; expedited PAs not submitted within 72 hours will be denied. - Failure to provide documentation within the 14-day extension window will result in PA denial and potential claim rejection. - Improper cost-sharing or prior authorization for breast cancer screening services may result in claim denials and patient refunds owed.