265.939 Electronic Billing
265.939 Electronic Billing: SUNSET HOD 2013
265.938 Contact Information Needed on EOMBs:
265.938 Contact Information Needed on EOMBs: It is MSSNY’s policy that the New York State Department of Financial Services should impose a new requirement on all third-party payers, requiring that these plans format their Explanation of Medical Benefits (EOMBs) to include the name and phone number of a responsible, readily available individual on the carrier
265.937 Changing of Prescriptions by Managed Care Organizations or Pharmacies:
265.937 Changing of Prescriptions by Managed Care Organizations or Pharmacies: MSSNY will seek regulation and/or legislation to mandate that health insurers recognize and reimburse for existing CPT codes for patient management activities when the insurer and/or PBM request the substitution of a prescription drug for that which has been prescribed. (HOD 2002-51; Reaffirmed HOD 2013; Reaffirmed HOD
265.936 Support the Health Insurance Guarantee Fund:
265.936 Support the Health Insurance Guarantee Fund: SUNSET HOD 2013
265.935 Third Party Payors Held to the Same Standard of Payment:
265.935 Third Party Payors Held to the Same Standard of Payment: MSSNY will seek legislation or whatever appropriate means are necessary to assure that third party payors are held to the standard of the Prompt Payment Law and that the provider should have the ability to collect payment from the patient if the claim is
265.934 Reduction of Surgical Aftercare Periods:
265.934 Reduction of Surgical Aftercare Periods: MSSNY will advocate for a maximum aftercare period of 30 days for reimbursement related to each surgical procedure. (HOD 2002-251; Reaffirmed HOD 2013; Reaffirmed HOD 2023)
265.933 Automatic Crossover of Payment between Medicare and Medicaid
265.933 Automatic Crossover of Payment between Medicare and Medicaid: SUNSET HOD 2019
265.932 Amendment to the Definition of “Covered Service” for Third Party Insurance Payment:
265.932 Amendment to the Definition of “Covered Service” for Third Party Insurance Payment: MSSNY has adopted as policy the following definition of covered service for insurance payment purposes. A covered service is defined as: (l) separately identifiable by the American Medical Association Current Procedural Terminology code; (2) allowed, reimbursable, and paid by the third party
265.931 Out-of-Network Status Should be Applied Only to Specifically Out-of-Network Providers:
265.931 Out-of-Network Status Should be Applied Only to Specifically Out-of-Network Providers: MSSNY will seek legislation that would prevent health insurance plans from refusing reimbursement to participating members of a medical team involved in the care of a patient when there is a non-participating member of the team involved in the patient’s care. Non-participating status would
265.930 Reimbursement for Well Child Visits:
265.930 Reimbursement for Well Child Visits: SUNSET HOD 2013
