New York State Delays PCRI Payments


Date Issued: 10/30/2014

The New York State Department of Health (NYSDOH) has again delayed the pass-through payment to the managed care organizations issuing mandated Primary Care Rate Increase (PCRI) payments to qualified practitioners. As a result, eligible primary care physicians and advanced practice clinicians who service our Medicaid members will not receive the PCRI payments from EmblemHealth for the first quarter of 2014 in the first week of October 2014, as expected. Eligible practitioners can expect to receive these payments mid-December.

As of October 30, 2014, the State has not made its lump-sum PCRI payment to EmblemHealth for the first quarter of 2014. This payment was due to EmblemHealth in the first week of September, 2014. The State now estimates this pass-through payment will arrive in mid-November. We will mail checks to eligible practitioners within 30 days of receipt of this payment, as mandated by the State.

Under the PCRI program, the State designates incentive payments to qualified primary care physicians and advanced practice clinicians working with a qualified physician. The PCRI program reimburses these eligible practitioners at 100 percent of the Medicare rates in the current payment year for services rendered to Medicaid Managed Care and Family Health Plus members under Evaluation and Management codes (99201-99499) and Vaccine Administration codes (90460, 90461, 90471, 90472 and 90474). These practitioners are verified by NYSDOH and the lump-sum payment remitted to EmblemHealth for distribution.

This delay will also have an impact on those eligible providers who are awaiting payment for previous quarters because of data issues that EmblemHealth encountered. We now anticipate releasing these checks on or about mid-December 2014, instead of October 31, 2014.

To ensure we mail your PCRI and other payments to the correct location(s), please update your profile any time your practice address changes or if you add or close a practice location.