[New York] August 2026 Provider Newsletter

MULTIPLE EFFECTIVE DATES - Prioritize by date: (1) By August 31, 2026: Review and act on ComplexCare Solutions SOAP note incentive program ending. (2) By September 1, 2026: Billing team must implement updates for: telehealth claims ICD-10-CM Excludes1 editing (Medicare Advantage/Medicaid), professional claims inpatient POS reporting accuracy (Medicaid), and observation service billing per CMS requirements (Medicare Advantage). Update billing system edits and provider encounter forms accordingly. (3) By October 1, 2026: Implement electronic claims and payments processing for Medicare Advantage to avoid paper administrative fees - update all claim submission workflows. (4) By November 1, 2026: Update reimbursement policies for modifiers 90, 91, and 92 for laboratory services (Professional and Facility billing) and sleep study bundled services/supplies (Professional) in billing software and fee schedules. (5) Throughout September-November: Implement expanded prior authorization requirements for: genetic testing (Commercial, effective July 1, 2026 - retroactive review needed), precertification changes (Medicare Advantage, effective November 1, 2026), specialty pharmacy expansion (Medicare Advantage, effective November 1, 2026), and medical benefit medications (Medicaid, effective September 1, 2026). Claims submitted without required prior authorizations will be denied.