Summer Provider Newsletter

REQUIREMENTS: By December 1, 2026: Billing and front desk teams must implement the following: - Update eligibility verification system to flag Medicaid Expansion patients (coverage codes 92, 93, 94, 95) for 6-month renewal cycles instead of 12-month cycles - Modify patient contact protocols to verify current address and phone number at every visit for all Medicaid Expansion enrollees to prevent missed renewal notices - Configure billing software to limit retroactive coverage requests to 1 month for Expansion-only eligible patients and 2 months for all other coverage groups - Create patient education materials explaining the new work requirement exemptions (medically frail, caregivers, veterans, pregnant/postpartum, etc.) and distribute at check-in - Train front desk and billing staff to encourage uninsured patients to apply immediately (by December 31, 2026) to maximize backdating eligibility under current 3-month window before reduction to 1-2 months Before January 1, 2027: Clinical and billing leadership must: - Review provider roster to identify physicians who may need to complete medical frailty attestation forms for patients with disabilities or complex medical conditions - Register staff for November 4, 2026 webinar on Medical Frailty and Community Engagement Work Requirements - Update claim submission procedures to ensure referring care management provider NPI is included in locator 78 or 79 for all inpatient hospital claims - Establish process to monitor DSS Claims Work Queue for pended inpatient claims missing referring provider information Consequences: Failure to implement these changes will result in increased claim denials for missing referral information, patient coverage gaps due to missed renewal deadlines, and potential retroactive claim denials if patients apply after January 1, 2027 with insufficient backdating eligibility.