New York

To calculate a New York Medicaid claim at 100% of the state regulation rates, use the default settings. All fields are required.

Note: Refer to the contract to determine the options to select and the values to enter.

The following table describes the fields on the NY tab of the Medicaid - Facility reimbursement tool.

Field

Description

Override Provider Number

Preferred provider number. Up to ten alphanumeric digits.

Override Service Date

Preferred service date. Use MM/DD/YYYY format. Overrides the service date on the claim with the date you enter. You may use the anchor date instead of this option.

State Code

This field defaults to NY, and it cannot be changed.

Do not consume charges

Provides the option not to consume charges. This is used for contract carve outs.

Do not consume units

Provides the option not to consume units. This is used for contract carve outs.

Percent Reimbursement

Three digit percentage amount.

APR-DRG

Managed Care

Selecting this check box changes the Operating Base Rate default amount for Medicaid to the Operating Base Rate for Medicaid Managed Care.

Workers Comp

Selecting this check box indicates that claims are to process using Workers Comp.

No Fault

Selecting this check box indicates that claims are to process using No Fault.

GME Managed Care

Selecting this check box indicates that claims are to process using GME Managed Care.

EAPG

Workers Comp

Selecting this check box indicates that claims are to process using Workers Comp.