564-New Medicaid Edit Limits for Claim Resubmissions Starting June 1, 2026

 New York Early Intervention System (NYEIS) Electronic Mailing List
 
 New Medicaid Edit Limits for Claim Resubmissions Starting June 1, 2026

Dear Colleague:

Effective June 1, 2026, New York Medicaid will implement a new editing rule that limits the number of times a claim may be submitted. Under this change, a claim will automatically deny after the fourth (4^th) resubmission attempt, allowing a maximum of five (5) total submissions, including the original claim. Claims that exceed the resubmission limit will be denied with Claim Adjustment Reason Code (CARC) 273, which will be reflected on the Medicaid remittance. Providers will receive code 273 after the 4th resubmission.  

Claims may deny for various reasons; therefore, depending on the issue/error of the claim, the denial reasons may differ.

All denied claims or claims with errors must be corrected and resubmitted within 60 days of the original denial date.  The four (4) allowed resubmissions must occur within 60 days or less than the date of the original denial. Medicaid will automatically deny any claim resubmitted on the sixth (6^th) attempt.

This five-submission limit is temporary, as it exceeds the regulatory maximum of three total submissions. New York Medicaid is working toward reducing the limit to align with this requirement under 18 NYCRR § 540.6, and additional updates are expected in the future.  

For questions or assistance, please contact the Bureau of Medical Review Claims Unit at (800) 342-3005 (Option 3) or pend@health.ny.gov. For additional details, please refer to the eMedNY communication released on May 14, 2026: New Edit 02292 – Multiple Claims Submission for the Same Service.