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NYEIS Voids Processing Initial Notification

The Early Intervention State Fiscal Agent (SFA) is initiating a project to process all accrued voided claim transactions for claims submitted and approved in NYEIS and paid by the SFA for the period April 1, 2013 through December 31, 2014. These voided claim transactions are for claims paid by commercial payers, Medicaid, and municipalities through the SFA escrow account. The processing of voids by the SFA is necessary to ensure that any paid claim voided by a provider is adjudicated appropriately.

As a reminder, the initial processing of voided claim transactions in the SFA system will result in payments owed to the payer(s) due to overpayments to providers. All overpayments resulting from voided claim transactions will be recouped by the respective payers who made payment on a claim. 

All overpayments made by municipalities via the escrow account will be immediately recouped by deducting the amount owed from the EI Billing Provider’s next escrow payment(s) following the processing of voided claim transactions for above period, until overpayment is fully recouped.

EI Billing Providers should check the current number and dollar amount for their voided claims in NYEIS. All Providers will also be notified by email on or before January 9, 2015 about the amount owed due to voided claim transactions.

EI Billing Providers can request an extended repayment plan if full recoupment of voided claims presents a financial hardship. The recoupment for providers requesting an extended repayment plan will occur over a period of ten weeks. Under the extended repayment plan, the amount owed by the provider will be divided across the ten week period to yield a weekly amount to be deducted from the escrow payment due. Voided claim transactions will be processed by the SFA by claim date on a weekly basis, as close to the weekly amount owed without splitting claims. Deductions may continue to be made beyond the ten week period if necessary to fully recoup payments.

EI Billing Providers wishing to request this extension must do so via email to no later than January 13, 2015. Please include “Request for Repayment Plan for Voided Claims” in the subject line of the email. Providers will receive an email acknowledgement confirming their extended repayment request.

Voided claim transactions involving third party payers (commercial insurance and Medicaid) will be processed by the SFA with the payer. Overpayments made to providers by commercial insurers or the Medicaid Program will be recouped directly by those payers from the provider. Medicaid will recoup the funds through future claim payments to EI Billing Providers. Commercial insurers may recoup payments owed by providers through a deduction to future payments or may request the EI Billing Provider to make a repayment by check. New York State law requires commercial insurers provide 30 days of notice to providers prior to initiating recoupment.

Beginning the week of January 19, 2015, the SFA will initiate the weekly processing of voided claims transactions in NYEIS to avoid accrual of overpayments by EI Billing Providers.

EI Billing procedures for voided claims can be accessed here: Billing and Claiming Operational Policies – Voided Claims

Void procedures for KIDS claims submitted by EI Billing Providers are under development.

If you have any questions or concerns about the NYEIS voids recoupment process, please contact the PCG Customer Service Center at (866) 315-3747.

Article ID: 217, Created On: 12/29/2014, Modified: 10/28/2015

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