Author Topic: Medicaid (NY) Billing for Therapies under 95 Exemption  (Read 1364 times)


  • Newbie
  • *
  • Posts: 1
Medicaid (NY) Billing for Therapies under 95 Exemption
« on: October 14, 2015, 01:24:09 PM »

My office recently switched our facility billing NPI and now we are having a hard time getting a specific type of claim paid by Medicaid.  Our population consists of many MR/DD individuals who have 95 Exemptions listed on their Medicaid eligibility listings.  The patients we are having an issue with have a Managed Care plan but are allowed to be directly billed to Medicaid by use of a Special Handling code on the claim.  However all of our claims are denying at Medicaid and when we call to inquire about it they tell me that the special handling code is causing their system to flag the incorrect specialty code.  I have contacted CSC, DOH and have even had our area CSC representative come to my office to try to solve this issue.

Has anyone here had a similar issue?


  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4770
    • Solutions Medical Billing
Re: Medicaid (NY) Billing for Therapies under 95 Exemption
« Reply #1 on: October 16, 2015, 10:48:05 AM »
No but it sounds like it is with how they have you loaded into their system. It sounds like you are in NY?
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF