Medicaid New York Claims Processing

Last updated
Save as PDF

About NY FFS DCN Claims Processing

Allscripts Homecare automatically creates an adjustment claim when a billed service is changed. New York Medicaid requires adjustment claims to include a NY FFS DCN when submitting the replacement. There may be situations, however, when the NY FFS DCN is not available in Homecare, in many cases, because the timing of the original claims processed by New York Medicaid and the subsequent electronic remittance advice (ERA) file being received and processed in Homecare. When an adjustment claim does not have a NY FFS DCN, and one is required, the application identifies that the claim is missing a NY FFS DCN by placing a check in the NY FFS DCN column of the Review EMC, Generate EMC, Regenerate EMC, and Late EMC windows.

Homecare can automatically defer adjustment claims when the NY FFS DCN is not identified in the application. This function is controlled by the Defer adjustment claims when NY FFS DCN is not determined for the original claim setting in Administration > Financial > Insurance Codes > EMC.

Determine Submission Status Window

Claims > Process > Determine Submission Status

If you click the Process button for a cycle that contains an adjustment claim that does not have a payment or adjustment applied or a NY FFS DCN number associated, the system displays the Determine Submission Statuswindow, which shows the services associated with the original claim. If the original claim was submitted to New York Medicaid, no action is necessary on this window. Click OK if all of the detail information was submitted to the payer. If the original claims were not submitted to the payer, select the services that the adjustment is for. By selecting a service in this window, the system identifies the new service as an original claim that does not require a NY FFS DCN. If the original claim was submitted to New York Medicaid, a NY FFS DCN number is required to submit the adjustment claim.

Note: This window enables you to update the type of bill to identify an original or adjustment claim.

Tip: If you use this window to note a detail claim that is not the claim submitted to New York Medicaid for processing, you must identify the original detail line in this window. To help identify an individual service, specify the date of service of the original detail claim. The start and end dates in this window show the date of service.

Processing Adjusted Services for Original Claims Generated Prior to Update

Option 1

1.	Enter the NY FFS DCN in Allscripts Homecare for the original services.

2.	Complete the service correction/adjustment.

A replacement claim is generated in Allscripts Homecare that includes all services in the original summary claim.

3.	Process the cycle or define an immediate cycle for the services. Follow your agency's standard procedures for processing claims in the Process a Cycle window.

4.	In the Generate EMC window, select the appropriate detail claim (date of service) to submit to the payer.

5.	Submit the EMC file using your agency's standard policy and procedures.

Option 2

Note: To use this option, you must download and install the DCN Utility from the Client Support website under Downloads. You must also have access to the electronic remittance advice files (ERA) for which the original claims have been paid or adjusted.

1.	Generate and close the adjustment claim in Allscripts Homecare. Do not submit these claims in the electronic file. Follow the next steps to obtain the NY FFS DCN information for online submission through EPACES.

2.	In the Welcome window of the utility, click the button to connect to the database, and then click Next.

3.	To direct the utility to the Allscripts Homecare database, click Specify. Ensure that the test connection is successful before you click OK to close the window.

4.	After establishing connection to the Allscripts Homecare database, select the Import ERA Files option, and then click Next.

5.	Click Add to select the ERA file and load it into the utility, and then click Open.

6.	In the Import window, click Next. The ERA file is processed.

7.	Click Finish to conclude the process.

8.	In the Welcome window, generate the DCN Report. Review the report and locate the NY FFS DCN for the adjustment claim you are processing.

9.	Enter the adjustment claim manually into EPACES using the NY FFS DCN information obtained through the Remittance Advice DCN Report.

Processing Adjusted Services

1.	Go to Claims > Process > Process a Cycle.

2.	Select the cycle to process.

3.	Click Process.

The claim view in the Process a Cycle window is in a single summary line for the billing period.

If a claim is being processed, and the original claim does not have a NY FFS DCN or payment associated, the Determine Submission Status window opens. If the original claim to the adjustment was not submitted to New York Medicaid for processing, select the claim from this window. Thus, the system treats the adjustment claim as an original claim for New York Medicaid processing.

4.	Close the cycle following your agency's standard billing policy and procedures.

5.	Upon closing the cycle, you can submit or generate an electronic billing file for claims generated in the cycle.

The claim view in the Generate EMC window is in detail format (one line for a resource, date of service, or revenue code).

Adjustment claims that do not have a NY FFS DCN associated with the original claim have a check mark in the NY FFS DCN column. Settings defined in Administration > Financial > Insurance Codes > EMC determine whether the claim is deferred until a NY FFS DCN is assigned. If the NY FFS DCN Override option is selected for the cycle, the system submits all claims in the cycle regardless of the NY FFS DCN status of the original claim. You cannot override specific claim details for submission.

6.	Submit the electronic billing file to New York Medicaid following your agency's standard policy and procedures.

7.	Apply the New York Medicaid ERA file.

Processing Deferred Claims Due to No NY FFS DCN

Follow this process after a NY FFS DCN has been associated with the original claim.

1.	Go to Claims > Process > Late EMC.

If an original claim has an associated NY FFS DCN, the status of the claim is automatically updated from Defer to Submit.

Note: If the Defer claims when orders are not signed check box is selected in Administration > Financial > Insurance Codes > EMC, the status of claims is updated from Defer to Submit when the signed order is posted in Transactions > General > Process Signed Documents, Transactions > General > Accelerated Posting of Documents, or the Physician Portal.

2.	Click Generate.

The electronic billing file is generated and can be submitted to New York Medicaid following your agency's policy and procedures.