Claims Delayed Due to Natural Disaster to Pend/Deny for Edit 02223 Delay Reason Code 15 (Natural Disaster) Invalid

NY Medicaid allows limited use of delay reason 15 “Natural Disaster” following a declaration of State Disaster Emergency in a provider’s county. Effective 9/19/2013, claims with dates of service over 90 days old, submitted with Delay Reason 15 “Natural Disaster”, cannot be electronically submitted and must be on paper claim forms with the eMedNY Delay Reason Code Form and supporting documentation. The documentation must explain the reason for the delay and provide a sequence of events including when submission came within control of the provider. These claims will pend for edit 02223 – Delay Reason Code 15 (Natural Disaster) Invalid and will be subject to prepayment review. The eMedNY Delay Reason Code Form is available online in page 3 of FOD – 7001: https://www.emedny.org/HIPAA/QuickRefDocs/FOD-7001_Sub_Claims_Over_90_days_Old.pdf

Source: eMedNY All Provider Types listserve 9/13/2013