Medicaid in Education Alert

30 Mar 2016

An important Medicaid reimbursement processing change will take place during the 2016-17 school year. The contract with the Central New York Regional Information Center (CNYRIC) that provides a system for the submission of school district claims for Medicaid reimbursement will not be extended beyond 2016-17. Therefore, school districts will have to plan for a transition to direct claiming using the New York State Department of Health’s (DOH) Medicaid Management Information System (MMIS). It is anticipated that School districts will be authorized to begin direct claiming this summer, even though the requirement to complete the transition will not occur until the 2016-17 school year.

The benefits to submitting claims directly to the DOH Medicaid claims processing system, eMedNY, for school districts include:

  • Enabling school districts to submit for reimbursement in real time and not restricted by the current monthly claiming calendar.
  • Allowing any necessary action on the part of the school district to take place timely when or if the claim requires and adjustment. This will result in fewer claims being time barred.
  • Having access to the most current student eligibility information through the Electronic Provider Assisted Claim Entry System (ePACES) without lag time for matching student demographic information on a monthly basis.

School districts will also have the ability to create or submit claims and other transactions in HIPAA format using ePACES, a web-based application.

Additional information will be issued within the coming months through NYSED and DOH.