New York Medicaid: Claim denials for non-enrolled providers
As of Oct. 1, 2022, we have begun to deny claims submitted to the UnitedHealthcare Community Plan of New York by providers who are not enrolled with the state Medicaid program. All NPI’s on the claim must be enrolled in order for the claim to process for payment including:
If your claim is denied due to a non-enrolled status, you will see a denial code of Q3V or Q7J.
This policy aligns with the 21st Century Cures Act, which requires all Medicaid Managed Care (MMC) and Children's Health Insurance Program network providers to be enrolled with state Medicaid programs no later than Jan. 1, 2018.
You will not need to resubmit claims once the enrollment process has started. Automated reprocessing projects will occur monthly to adjust claims for providers who have become enrolled with NY State Department of Health.
Resources and supporting information
For more information, view the following resources: