All responsible providers who received a letter from Managed Care Organization (MCO) stating that they were identified, as a non-enrolled NYS Medicaid Program providers and were rendering services to their Medicaid eligible members, started sending enrollment applications to Medicaid.
Currently, there are 10 000 new applications pending DOH decision including those awaiting additional information from providers.
CMS has advised States that it does not recommend termination of providers who did not enroll as of January 1, 2018, given that it would cause access to care issues. At this time, MCOs should not be initiating terminations relating to failure to enroll in Medicaid. MCOs should send out provider contract amendment, check enrollment and pending enrollment data to track compliance, identify and reach out to providers who have not complied. The Department will be providing further guidance and recommendations regarding additional compliance measures MCOs may utilize prior to termination.
Pursuant to a 21st Century Cures Act Section 5005, no later than 7/1/2018, MCOs must amend contracts with providers to include a provision that requires providers to enroll in Medicaid program. However, if the providers fail to enroll, such providers shall be terminated from participating as a provider in any network of the MCO that serves individuals eligible to receive Medicaid and CHP.
In case provider is terminated from, not accepted to, or fails to submit Medicaid enrollment application by 7/1/2018, the provider shall be terminated from the network.
The notice of amendment should include an “opt out provision" allowing the provider an opportunity to terminate the contract. If the provider chooses to opt out, the provider is terminating the contract.
WCH Service Bureau recommends our providers to enroll in State Medicaid Program as soon as possible to avoid termination and remain participating status in MCOs. Our credentialing team is always here to help and answer any questions related to the process for any specialty. We are ready to assist you in this important matter.
Call us now and let your practice keep the smooth course!