09 OHIP ADM-3 2025

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The document is an Administrative Directive from the New York State Department of Health outlining the Medicaid Extended Coverage available to policyholders of the New York State Partnership for Long-Term Care. It details the purpose, background, program implications, definitions, and eligibility criteria for two types of insurance plans: Total Asset Protection (TAP) and Dollar-for-Dollar Asset Protection (DDAP). The directive explains how these plans affect Medicaid eligibility, resource treatment, and the process for applying for Medicaid Extended Coverage after exhausting long-term care benefits. It emphasizes financial independence through shared responsibility between consumers and the state in funding long-term care.

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What is the error code EQ3?

EQ3 Health Care Provider is registered as OPTED-IN for date of service. Claim submitted as Pay Patient.

What is the error code AT3 on OHIP?

If a K303A is claimed and an existing/ongoing patient-physician relationship does not exist on the service date, the service will reject to the physicians error report with the error code AT3 No Pat-Phys Relationship.

What is the version code error for OHIP?

OHIP Error Code - EH2 - Invalid version code The current version code becomes invalid when the patients health card expires, the patient renews his/her health card, or it is reported lost/stolen. Solution: To correct an EH2 error, you will need to contact the patient for the new version code.

What is the error code AT3 on OHIP billing?

AT3 No physician/patient relationship exists Virtual requirements not met. Rebill A101A/A102A based on visit type. AT4 Modality is not allowed with fee code Remove the fee code without a modality code and rebill on individual claim.

What is a D3 error on OHIP billing?

D3 Service Fee Code Not Allowed in Addition to Visit Fee The OHIP rules state that certain procedure codes cannot be billed together with a general assessment on the same day for the same patient. To fix a D3 error: Review the billing codes submitted on the claim.