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DOH on Non-Regulated Insurance Plans Billed in Error

Guidance on Non-Regulated Insurance Plans Billed in Error

Service Coordination Responsibilities

Dear Colleague:

Service coordinators are responsible to obtain insurance information from families and to update this information as needed to ensure it is accurately documented in the Department’s data systems (NYEIS and KIDS). It is this documentation in the data system which drives third party insurance billing. The data in NYEIS is sent to the State’s fiscal agent in order to process claims.

Service coordinators should proceed to verify insurance information for all children on their caseloads, immediately and regularly thereafter.

  1. For children whose records are maintained in the KIDS system: Service coordinators must provide the insurance information to the municipality to record. Municipalities must correct the insurance information maintained in the KIDS system.

  2. For children whose records are maintained in the NYEIS system: Service coordinators must enter accurate information in NYEIS regarding the regulated status of the family’s insurance plan.

    • To accurately identify whether an insurance plan is regulated by New York State Insurance Law, service coordinators should contact the insurance company directly. Please note, the determination is made at the plan level (e.g., a single insurance company may have some plans that are regulated and others, such as self-funded plans, that are typically not regulated).*

    • On the child's commercial insurance page in NYEIS, there is a drop down box to indicate whether the plan is, or is not, regulated by New York State. Service coordinators must select the appropriate option in order for family’s insurance benefits to be protected.**

    • There also is a required field on the child's commercial insurance page in NYEIS for parental consent to bill insurance that is not regulated by New York State. Service coordinators must choose either “Yes” or “No” in this field.**

    • Please note, if the parent declines to provide insurance information, this declination must also be documented. On the child's home page in NYEIS, there is a cluster labeled Insurance Information and a field to indicate if the parent declined to give insurance information.**

*Face-to-face and telephone contacts with insurers for the purpose of determining the regulated/non-regulated status of a family’s commercial insurance plan are billable service coordination activities. Contacts made by e-mail or letter are not billable.

**Detailed procedures for entering insurance can be found in the NYEIS User Manual, Unit 10, Municipal Administration (the User Manual describes this as a municipal function, however, with the promotion of NYEIS Version 2.0 and 3.0, service coordinators now have the ability to enter insurance information). In addition, a webinar will be presented in the near future to walk through the process of adding/editing insurance information in NYEIS.

Should you have additional questions, please email

If you have any questions or need further information regarding NYEIS, please contact the NYEIS helpdesk at or 518-640-8390.

Please do not reply to this e-mail announcement.

Thank You.


Article ID: 133, Created On: 11/14/2013, Modified: 10/27/2015

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