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Notice: Code 35 Claims Payment to Providers

 New York State Department of Health

New York Early Intervention System (NYEIS) Electronic Mailing List

Code 35 Claims Payment to Providers

Dear Colleague:

In follow-up to the previous communication to the field on unresolved service coordination claims due to Code 35 restriction:

On October 21, 2014, the Early Intervention State Fiscal Agent (SFA), processed a special check run totaling $1,423,971.82 for service coordination services claims submitted to Medicaid that remained unresolved for over 90 days as of October 1, 2014, due to the child being a restricted recipient and the current provider not on Medicaid’s file for the child.

Claims selected for reimbursement meet the following two criteria:

·         Early Intervention (EI) service coordination claims received by EIBilling prior to July 1, 2014. 

o    For NYEIS: Claims received by the SFA for processing prior to and including Monday, June 30, 2014

o    For KIDS: Claims approved and processed by the municipality prior to July 1, 2014

  • Service coordination services claims remain unpaid and in a Code 35 Medicaid denial status

As a reminder, the SFA will continue to pursue Medicaid reimbursement for service coordination services claims and adjustments will be made to provider payments as Medicaid payments are received for these claims.

If you have any questions, please call the PCG Customer Service Center at (866) 315-3747. 

Article ID: 200, Created On: 10/23/2014, Modified: 5/8/2017

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