Situation Report | August 24, 2020
Due to changes in the eMedNY edit process, effective March 1, 2020, upon the death of a waiver participant, providers may now bill for ongoing service coordination (rate codes 9775//NHTD, 9851/TBI) twice in one month. This would provide for the routine billing on the first of the month for services rendered in the prior month and allow for an additional claim for Service Coordination on the date of death.
This allows the provider to bill for services provided after the first of the month leading up to the date of the participant’s death. Providers are required to adhere to all eMedNY billing guidelines, and the billing date of service must be before the date of death. All waiver documentation requirements remain in effect.
Providers may bill for these services retroactive to March 1, 2020 but will require a delay reason code of 03.
Please note that providers may not bill for Initial Service Coordination at any time if an applicant does not reach full waiver eligibility due to death.
All questions regarding these changes may be directed to the waiver mailbox at waivertransition@health.ny.gov.