New York Medicaid: Enroll with state to avoid claim denials
Under the 21st Century Cures Act, all health care providers in Medicaid Managed Care (MMC) and Children’s Health Insurance Program (CHIP) networks must enroll with state Medicaid programs. Managed Care Organizations (MCOs), like UnitedHealthcare, are required to deny claims from health care providers who are not enrolled.
During the COVID-19 Public Health Emergency (PHE), UnitedHealthcare Community Plan of New York allowed automatic reprocessing of claims for retroactively enrolled health care providers. That time has ended. As of April 1, 2024, the PHE ended, which means we must deny your claims if you’re not an enrolled Medicaid health care provider.
How to enroll/check your enrollment status
To verify whether you’re registered as a Medicaid health care provider, please review the following lists:
If you need to enroll with New York Medicaid and obtain a Medicaid Management Information System (MMIS) ID, go to the Provider Enrollment & Maintenance page on the New York State Department of Health site and select New Enrollment.
What you can do
If we denied your claim because of a missing MMIS ID, the denial notification will include 1 of the following explanation codes:
| Expiration code | Description |
|---|---|
| QSA | Billing provider validation issue |
| QSB | Billing provider validation issue |
| QSC | Rendering provider validation issue |
| QSD | Rendering provider validation issue |
| QSE | Referring provider validation issue |
| QSF | Referring provider validation issue |
| QSG | Service provider validation issue |
| QSH | Service provider validation issue |
| QSJ | Attending provider validation issue |
| QSK | Attending provider validation issue |
| QSL | Operating provider validation issue |
| QSM | Operating provider validation issue |
| QSN | Other provider validation issue |
| QSP | Other provider validation issue |
| QSV | Ordering provider validation issue |
| QSW | Ordering provider validation issue |
| QSX | Supervising provider validation issue |
| QSY | Supervising provider validation issue |
Submit a payment reconsideration request
You can submit a claim reconsideration if you’ve retroactively enrolled with Medicaid. Your enrollment dates must be prior to the date of service on the claim.
To submit a reconsideration request, use the UnitedHealthcare Provider Portal:
- Go to UHCprovider.com and click Sign In at the top-right corner
- Enter your One Healthcare ID and password
- New users without a One Healthcare ID: Visit UHCprovider.com/access to get started
- In the menu, select Claims & Payments > Look up a Claim and enter your search criteria
- Find your claim and click on the claim number to see details
- Scroll down to the Act on a Claim section and select Create Claim Reconsideration
- Complete the fields and attach supporting documents as needed
Visit our interactive guide to learn more about reconsiderations and appeals/disputes.
Questions? We're here to help.
Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal. For additional contact information, visit our Contact us page.
PCA-1-24-03023-POE-NN_10182024
