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Early Intervention Program Progress Report – Excellus

 

New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List

Early Intervention Program Progress Report – Excellus


Dear Colleague:

The Department is pleased to report that substantive progress has been made in ensuring that insurance payments from Excellus Health Plan are issued directly to EIP billing providers and claims adjudication information is directed to the Department’s interim fiscal agent, James McGuinness Associates (McGuinness). 

Beginning Friday, September 6, 2013, Excellus has implemented technical changes to its claims processing systems that will ensure that EIP claims are recognized, payments are appropriately issued to the EIP billing provider, and remittance advices with claims adjudication information is sent to McGuinness.  This change will substantially improve the timeliness of EIP claims processing and payment to EIP providers from Excellus Health Plan.  

Excellus Health Plan includes Excellus BlueCross BlueShield and Univera Healthcare. Excellus BlueCross BlueShield covers the following counties: Monroe; Wayne; Livingston; Seneca; Yates; Ontario; Steuben; Schuyler; Chemung; Tioga; Tompkins; Cortland; Broome; Cayuga; Onondaga; Oswego; Chenango; Madison; Delaware; Otsego; Herkimer; Montgomery; Fulton; Oneida; Lewis; Hamilton; Essex; Clinton; Franklin; St. Lawrence; and Jefferson. Univera Healthcare covers the following counties: Allegany; Cattaraugus; Chautauqua; Erie; Genesee; Niagara; Orleans; and Wyoming.  Please note some of the other Bluecross Blueshield plans that are not part of Excellus also provide coverage to some of these counties, so they are not exclusively Excellus counties. EIP providers doing business in these counties will begin to see improvements in Excellus Health Plan claims processing as early as mid-September.

Excellus Health Plan does not include the following entities: Empire BlueCross BlueShield, Blue Cross and Blue Shield of Western New York, and Blue Shield of Northeastern New York.  The Department continues to work with these and other companies to implement similar solutions to ensure payments are appropriately made to EIP providers and remittance advices are issued to the Department’s fiscal agent.

The following actions are being taken by Excellus Health Plan to address issues with EIP claims submitted prior to September 6, 2013:

Excellus Health Plan has provided reports to McGuinness detailing EIP claims adjudication results for claims submitted April 1 through September 5, 2013, to allow McGuinness to complete the processing of these claims and work with providers to resolve outstanding issues on incomplete or inaccurate claims.  Providers should begin receiving payments from the county funded escrow account for these adjudicated claims beginning this week.

Excellus Health Plan is issuing a letter to all EIP parents who are members of Excellus Plan and who received a misdirected check for early intervention services.  This letter, which is enclosed and was sent to parents Friday, September 6, 2013, instructs parents who have cashed a check to pay their EIP providers and give the EI provider a copy of the explanation of benefits included with the check.  The letter instructs parents who have not cashed the check to sign it and give it to the provider.  Excellus Health Plan and the Department are issuing the enclosed letter to EIP providers instructing them to accept checks and payments from families.  If a family is not open to reissuing payment to the EIP provider, or if the EIP provider prefers to directly work with Excellus for reissuance of payment, a representative of Excellus will assist the provider in securing reissuance of the payment.

Thank You




Please note, the following attachments were included on this email from the BEI:

Article ID: 119, Created On: 9/17/2013, Modified: 10/27/2015

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