This article has links to references for various codes for Medicaid eligibility and billing.
1. ELIGIBILITY CODES
When you prepare for a fair hearing and obtain an evidence packet, and in some other instances, you obtain screenshots from the eMedNY system - the computer system that stores Medicaid eligibility information, which providers use to look up eligibility of their patients. Local Medicaid offices or the NYSofHealth enter these codes into the system.
Here are a few references that might shed light on what some of these codes mean:
Down the road we hope to post more helpful guides to understanding the most common eligibility codes.
2. BILLING CODES for Home Care and Adult Day Health
- MLTC and managed care plan notices often use strange-looking codes to describe the approved shift for home care. These codes can be found in Universal Billing Codes for Home Care and Adult Day Health Care Services (NYS DOH) - has billing codes for live-in, mutual cases, CDPAP vs. personal care, private duty nursing, etc. Note that some codes look the same but have a different "modifier" - such as for mutual cases (oen aide is assigned to care for two people in the household)..
- Annoyingly, home care is billed in 15-minute increments. That makes notices difficult to read.
