Pending Claims Before Edits are Set to Deny Effective October 1

In September 2013, a series of claim edits will be placed on a schedule of one week payment holds to assist servicing providers with identifying non-enrolled ordering, referring and attending providers. Claims failing these edits will be released for processing after the one week payment hold. The remittance advice will indicate the edit failed and the pend status of these claims.

Servicing providers should continue to use the OPRA Provider Search feature found on https://www.emedny.org/info/ProviderEnrollment/index.aspx

Source: eMedNY General Updates listserve 9/4/2013

Source: https://www.emedny.org/info/ProviderEnrollment/ProviderMaintForms/Core_OPRA_FAQs.pdf