Personal Emergency Response Services (PERS) Billing ... - eMedNY

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CLAIMS SUBMISSIONeMedNY is the name of the electronic New York State Medicaid system. The eMedNY system allowsNew York Medicaid providers to submit claims and receive payments for Medicaid-coveredservices provided to eligible members.eMedNY offers several innovative technical and architectural features, facilitating theadjudication and payment of claims and providing extensive support and convenience for itsusers. CSC is the eMedNY contractor and is responsible for its operation.The information contained within this document was created in concert by eMedNY DOH andeMedNY CSC. More information about eMedNY can be found at www.emedny.org.PERSONAL EMERGENCY RESPONSE SERVICES (PERS)Version 2011 - 01 6/1/2011Page 2 of 9
TABLE OF CONTENTSTABLE OF CONTENTS1. Purpose Statement .......................................................................................................................................... 42. Claims Submission ........................................................................................................................................... 52.1 Electronic Claims ..................................................................................................................................................... 52.2 Paper Claims ............................................................................................................................................................ 52.3 PERS Billing Instructions .......................................................................................................................................... 52.3.1 UB-04 Claim Form Field Instructions .................................................................................................................................... 53. Remittance Advice ........................................................................................................................................... 7Appendix A Claim Samples...................................................................................................................................... 8For eMedNY Billing Guideline questions, please contactthe eMedNY Call Center 1-800-343-9000.PERSONAL EMERGENCY RESPONSE SERVICES (PERS)Version 2011 - 01 6/1/2011Page 3 of 9
Page 1: New York StateUB04 Billing Guidelin
Page 5 and 6: CLAIMS SUBMISSION2. Claims Submissi
Page 7 and 8: REMITTANCE ADVICE3. Remittance Advi
Page 9: APPENDIX A CLAIM SAMPLESPERSONAL EM

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