Action Required: Direct Care Worker Identifier Set Up by August 31, 2026
Impacted LOBs: Medicaid, HIV-SNP, HARP, MLTC, and MAP (UltraCare HMO D-SNP)
TO: Licensed Home Care Service Agency (LHCSA) and Certified Home Health Agency (CHHA)
Dear Valued MetroPlusHealth Provider,
NYS has updated electronic billing guidance for Direct Care Workers. Plans are to include this information for all encounters with dates of service starting October 1, 2026. Direct Care Workers will be identified using Home Care Registry IDs for all Home Health Aide and Personal Care service encounters.
The Department of Health, Office of Health Insurance Programs (DOH/OHIP), is requiring reporting of the following worker identifiers for applicable home care services:
- Home Care Registry ID for LHCSA and CHHA direct care workers.
Providers must submit the Home Care Registry ID as the rendering provider on all Home Health Aide and Personal Care encounters as follows:
| Description | Institutional Encounters (837I) | Professional Encounters (837P) |
|---|---|---|
| Direct Care Worker ID (Home Care Registry ID) | 2310A REF02 2420C REF02 (conditional) REF01 = G2 (Required if National Provider Identifier [NPI] is not available) | 2310B REF02 2420A REF02 (conditional) REF01 = G2 (Required if NPI is not available) |
| Example: | REF*G2*Home Care ID~ | REF*G2*Home Care ID~ |
For encounters where all lines are provided by the same Direct Care Worker, the 2310A/2310B loops can be used. If the encounter has services provided by multiple Direct Care Workers, the plan should submit the provider information on the 2420C/2420A loops.
To support testing and implementation activities prior to production use, providers are encouraged to work with their billing vendors and EDI teams to ensure all necessary system modifications are completed by August 31, 2026.
We appreciate your continued cooperation and commitment to our members. If you have any questions regarding this notice, please contact MetroPlusHealth at [email protected].