What do I do for the New York State Department of Health Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Billing Updates?

As of July 1st, 2025, the New York State Department of Health (NYSDOH) requires claims to be paid based on the county where services are provided for the Nursing Home Transition and Diversion (NHTD) and the Traumatic Brain Injury (TBI) Waiver programs.

Claims submitted without the correct codes for dates of service on or after July 1st, 2025 will be denied.

  • For Electronic Claims: Enter Value Code 85 plus the 5-digit Federal Information Processing Standards (FIPS) code in the Value Code box.

  • For Paper Claims: Enter Value Code 61 plus the 3-digit county locator code (a new 900 series code) in the Value Code box. This instruction only includes steps for Electronic Submissions.

Follow the steps below to set up the new Billing configurations to new requirements,

  1. Identify all Contracts that apply to TBI or NHTD.

    New Location Codes and Rate Codes are required for billing of visits that occur 07/01/2025 and after. The old requirements remain for billing of visits that occur 06/30/2025 and before.

  2. Create an Export Code for each of the five Rate Codes provided in the table below. Go to Admin > Reference Table Management > Export Code, select Export Code in the Reference Table dropdown, and then click Search.

    Export Code in Reference Table Management

    Click the Add button. Enter the following Rate Codes in the Export Code field, and then click Save.

    Add Export Code window

    Rate Code Service Counties
    9744 NHTDWVR HCSS-NYC REGION-HOURLY (Bronx, Brooklyn/Kings, NY/Manhattan, Queens, Richmond/Staten Island)
    9745 NHTDWVR HCSS-LONG ISLAND/WESTCHESTER REGION-HOURLY (Nassau, Suffolk, Westchester)
    9746 NHTDWVR HCSS-ROCKLAND REGION-HOURLY
    9747 NHTDWVR HCSS-REST OF STATE REGION-HOURLY
    9748 NHTDWVR HCSS-RURAL REGION-HOURLY (Allegany, Clinton, Delaware, Essex, Franklin, Hamilton, St Lawrence)

  3. Create new Service Codes to replace the old Service code. Go to Admin > Reference Table Management > Contract Service Code.

    We recommend creating one Service Code per county and name it accordingly, so each new code has the appropriate Location and HCPCS Code.

    Add Contract Service Code button

  4. Select the Add button, complete all fields, add the new Location Code in the Location Code field, select the correct Export Code in the Export Code field, enter the correct HCPCS Code in the HCPCS Code field, and then select Save.

    The HCPCS Code and Export Code for NHTD contracts of 9795 changes to one of the following new codes depending on the Service County:

    Contract Service Code

    Rate Code Service Counties
    9744 NHTDWVR HCSS-NYC REGION-HOURLY (Bronx, Brooklyn/Kings, NY/Manhattan, Queens, Richmond/Staten Island)
    9745 NHTDWVR HCSS-LONG ISLAND/WESTCHESTER REGION-HOURLY (Nassau, Suffolk, Westchester)
    9746 NHTDWVR HCSS-ROCKLAND REGION-HOURLY
    9747 NHTDWVR HCSS-REST OF STATE REGION-HOURLY
    9748 NHTDWVR HCSS-RURAL REGION-HOURLY (Allegany, Clinton, Delaware, Essex, Franklin, Hamilton, St Lawrence)

    The value in the Revenue Code field remains the same and should be copied from your prior Service Codes.

  5. Select Update Rate beside the old Contract Service Codes, and change the To Date to 06/30/2025.

    Contract Setup: Billing Rates: Updating a Rate

  6. Add Billing Rates to the new Contract Service Codes, go to Admin > Contract Setup > Billing Rates. Select the New Rate button, complete all fields, set the From Date field to 07/01/2025, and then select Save.

    Contract Rate

  7. Go to Admin > Contract Setup > Search Contract. In the Billing/Collections tab, select the Enable Office Level E-billing Configuration checkbox, and then select Save.

    If you do not see the Enable Office Level E-billing Configuration, contact HHAeXchange Support Team to enable the configuration.

    General Billing and Collections Configurations

  8. Select the Edit link from the Office field that displays besides the checkbox. Select Add Group to create a new E-billing Configuration. Enter the Group Name, enter the Start Date of 07/01/2025, and then select Save. We recommend the Group Name to include FIPS.

    You are configuring a modified E-Billing Setup to be effective for dates of service 07/01/2025 and after. The existing setup remains in effect for any dates of service 06/30/2025 or before.

    E-Billing Office Groups window

  9. On the HHAeXchange - E-Billing Configuration window, scroll to the 2300 HI*BE lines and select No for both Value settings. This setting puts the correct County FIPS code on the Claim that is required as a result of this billing change.

    The FIPS code is the County code of the Patients primary address. To quickly check that all Patients have a County listed, go to Report > Patients > List of Patients (Ent). Select your NHTD/TBI contracts from the dropdown and review the Patient Address fields.

    Set HI*BE Segments values to No

  10. Go to Patient > Search Patient. Select the correct contract in the Contract field and then select Search.

  11. Open each Patient and go to Auth/Orders page, select the View/Edit button from the Elipses.. under the Actions column, change the To Date field to 06/30/2025, and then select Save. Create new Authorizations for each patient with the new Service Codes starting 07/01/2025.

    Make sure to manage prior used authorization hours when adding the new authorization by updating the new Authorization with the remaining hours or units from prior Authorization.

  12. After the Patient authorization is updated, go to the Master Week page and update the existing Master Week(s) with the new Service Codes. Select Edit on the existing Master Week(s). Update the Service Code to the newly created service code. Then click Save.Then click the Save and Update button with a Start Date of 07/01/2025.

    After you update the Service Code on the Master Week, the Save and Update function only applies to Visits that do not have an EVV Confirmation. If any visit has an EVV Confirmation, you are then required to manually update the Service Code for each individual visit.

    Be sure to double check your pay code(s).

  13. Next, Follow the same Billing workflow as usual. When you create an E-Billing Batch, you receive two Batch results when you have batches running from before 7/1 and after. The first Batch includes the 837 file that has the Default Configurations from the E-Billing Configurations. The second Batch includes the 837 file that includes the new Group Configurations starting 07/01/2025. Ex. Batch Number_Group Name.