* § 363-e. Preclaim review for participating providers of medical
assistance program services and items. The department of health and the
office of the Medicaid inspector general shall jointly develop
requirements for preclaim review. Every service or item within a claim
or encounter submitted by a participating provider shall be reviewed and
verified by a verification organization prior to submission of a claim
or encounter to the department of health or to a managed care provider
as defined in paragraph (b) of subdivision one of section three hundred
sixty-four-j of this title. The verification organization shall declare
each service or item to be verified or unverified. Each participating
provider shall receive and maintain reports from the verification
organization which shall contain data on:
1. verified services or items, including whether a service appeared on
a conflict or exception report before verification and how that conflict
or exception was resolved; and
2. services or items that were not verified, including conflict and
exception report data for these services.
* NB Repealed January 1, 2024
* NB There are 2 § 363-e's
Structure New York Laws
Article 5 - Assistance and Care
Title 11 - Medical Assistance for Needy Persons
363-A - Federal Aid; State Plan.
363-D - Provider Compliance Program.
363-E - Medicaid Plan, Applications for Waivers and Plan Amendments; Public Disclosure.
363-F - Electronic Visit Verification for Personal Care and Home Health Providers.
364 - Responsibility for Standards.
364-A - Cooperation of State Departments.
364-B - Residential and Medical Care Placement Demonstration Projects.
364-C - National Long Term Care Channeling Demonstration Project.
364-D - Medical Assistance Research and Demonstration Projects.
364-E - Aid to Families With Dependent Children Homemaker/home Health Aide Demonstration Projects.
364-F - Primary Care Case Management Programs.
364-G - Medical Assistance Capitation Rate Demonstration Project.
364-H - Foster Family Care Demonstration Programs for Elderly or Disabled Persons.
364-I - Medical Assistance Presumptive Eligibility Program.
364-J - Managed Care Programs.
364-J-2 - Transitional Supplemental Payments.
364-JJ - Special Advisory Review Panel on Medicaid Managed Care.
364-KK - Condition of Participation.
364-M - Statewide Patient Centered Medical Home Program.
364-N - Diabetes and Chronic Disease Self-Management Pilot Program.
365 - Responsibility for Assistance.
365-A - Character and Adequacy of Assistance.
365-B - Local Medical Plans: Professional Directors.
365-C - Medical Advisory Committee.
365-D - Medicaid Evidence Based Benefit Review Advisory Committee.
365-E - Optional or Continued Membership in Entities Offering Comprehensive Health Services Plans.
365-F - Consumer Directed Personal Assistance Program.
365-G - Utilization Review for Certain Care, Services and Supplies.
365-H - Provision and Reimbursement of Transportation Costs.
365-K - Provision of Prenatal Care Services.
365-M - Administration and Management of Behavioral Health Services.
365-N - Department of Health Assumption of Program Administration.
365-O - Provision and Coverage of Services for Living Organ Donors.
366-A - Applications for Assistance; Investigations; Reconsideration.
366-B - Penalties for Fraudulent Practices.
366-C - Treatment of Income and Resources of Institutionalized Persons.
366-D - Medical Assistance Provider; Prohibited Practices.
366-E - Certified Home Health Agency Medicare Billing.
366-F - Persons Acting in Concert With a Medical Assistance Provider; Prohibited Practices.
366-G - Newborn Enrollment for Medical Assistance.
366-H - Automated System; Established.
366-I - Long-Term Care Financing Demonstration Program.
367 - Authorization for Hospital Care.
367-B - Medical Assistance Information and Payment System.
367-C - Payment for Long Term Home Health Care Programs.
367-D - Personal Care Need Determination.
367-E - Payment for AIDS Home Care Programs.
367-F - Partnership for Long Term Care Program.
367-G - Authorization and Provision of Personal Emergency Response Services.
367-H - Payment for Assisted Living Programs.
367-I - Personal Care Services Provider Assessments.
367-O - Health Insurance Demonstration Programs.
367-P*2 - Payment for Limited Home Care Services Agencies.
367-Q - Personal Care Services Worker Recruitment and Retention Program.
367-R - Private Duty Nursing Services Worker Recruitment and Retention Program.
367-S - Long Term Care Demonstration Program.
367-S*2 - Emergency Medical Transportation Services.
367-T - Payment for Emergency Physician Services.
367-U - Payment for Home Telehealth Services.
367-V - County Long-Term Care Financing Demonstration Program.
367-W - Health Care and Mental Hygiene Worker Bonuses.
368-B - State Reimbursement to Local Health Districts; Chargebacks.
368-C - Audit of State Rates of Payment to Providers of Health Care Services.
368-E - Reimbursement to Counties for Pre-School Children With Handicapping Conditions.
368-F - Reimbursement of Costs Under the Early Intervention Program.