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IFA Processing of Claims





For children enrolled in NYEIS, the NYEIS system will run edit checks on claims as previously done before sending claims to the Fiscal Administration System.


For children enrolled in KIDS, a county will use the new KIDS billing process to upload a batch claim to EI Billing. All valid claims will then be sent to the Fiscal Administration System. Providers will be able to view invalid claims to be fixed and resubmitted.





For children enrolled in both NYEIS and in KIDS, the Interim Fiscal Administrator (IFA) will submit all valid claims to insurance companies.  The IFA will examine denied claims from an insurance company to see if they are "workable" or "non-workable."  If an insurance company accepts a claim, a check covering the agreed-upon portion of the claim will be sent directly to the provider.  If there is a remaining balance on the claim, the IFA will send the claim to all possible insurance companies before sending the claim to Medicaid.  The IFA can only bill one insurance company at a time.

Once a claim has been sent to Medicaid, Medicaid will either send a check covering an agreed-upon portion of the claim directly to the provider, or will deny the claim.

The IFA will run a bi-weekly "sweep" through the Fiscal Administration System.  This sweep will bring the attention of the IFA to claims that have been fully paid, as well as any claims that have not been fully paid but have exhausted commercial insurance and Medicaid as avenues of billing.  All claims will be processed by the IFA, which will issue for checks to be written from the state escrow account.    If the county has exhausted its portion of the state escrow account, the bill will be held and the provider will not be paid until the county has replenished the account.  For children enrolled in KIDS, reports and reconciliation will be made available for download on EI BIlling. 

For children enrolled in both NYEIS and in KIDS, the Interim Fiscal Administrator (IFA) will submit all valid claims to the insurance companies and Medicaid.  Providers will then receive payment directly from the insurance companies and Medicaid.

The IFA will run a bi-weekly "sweep" through the Fiscal Administration System to account for claims that have been fully paid, as well as to process claims that will be paid out of the state escrow account.
  The provider will be notified if a payment has been held due to insufficient funds in the county's portion of the escrow account. -- To replace above paragraphs

For a more in depth overview of the Interim Fiscal Agent Process for Early Intervention for Counties, please click here.


Article ID: 17, Created On: 4/12/2013, Modified: 10/28/2015

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