Article Rating

  • 0 Rating(s)
  • 0
  • 0
  • 0
  • 0
  • 0

Medicaid Service Coordination Management

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

Medicaid Service Coordination Management


Subject: Service Coordination/Case Management Enrollment/Disenrollment Form with Instructions

Date: March 25, 2015

Purpose: Provide information and a standardized form for the assignment of the Medicaid Exception Code 35 which allows for Medicaid reimbursement for service coordination (SC) services delivered by the Early Intervention Program (EIP).

Under Medicaid only one billing provider may be reimbursed for a child’s SC services at a given time. The Medicaid Exception Code 35 identifies the SC provider. In order for reimbursement to be claimed for EI SC services the Local Department of Social Services (LDSS) in the child’s transaction district (most often the county in which the child resides) or the Bureau of Medicaid Enrollment and Exchange Integration (NYSoH), must combine the child’s Code 35 Restriction/Exception Subsystem with the billing provider’s Medicaid Provider Identification number in the Welfare Management System or eMedNY (electronic Medicaid system). This code has no effect on any of the other services that a Medicaid eligible child needs.

To assist the LDSSs/NYSoH and EI SC providers with the enrollment/disenrollment process the Bureau of Early Intervention and the Bureau of Medicaid Enrollment and Exchange Integration are providing a suggested form (Exception Code 35: Case Management Change Form), plus associated instruction sheets. This form was modeled after similar forms currently being used. Do not combine enrollment and disenrollments. Use separate forms for each type of request.

It is our hope that the suggested form will help to ensure accurate Code 35 assignments in a timely manner.

If you have questions please contact the Bureau of Early Intervention by emailing beipub@health.ny.gov.

Additional Guidance:

  • Code 35s must be entered and removed from a child’s Medicaid record. The attached form can be used to manage both. Please do not mix the Type of Request, rather use a separate form for each type.
  • As a reminder if you are no longer providing SC to a child you must disenroll them so that they can be assigned to a new SC provider
  • Enrollment/disenrollment dates must match the correct start and end dates associated with the provider’s SC service authorization for the child.
  • As part of the SC biller’s responsibility, they should develop a routine of notifying the child’s transaction district when a Code 35 must be enrolled or disenrolled. Requests for children enrolled through NYSoH Medicaid (H78) are being handled by NYSoH Exceptions. See Exception Code 35: Case Management Change Form (page two) or Municipal Contacts for Code 35 Revisions for additional information.

Attachments:

Exception Code 35: Case Management Change Form

Municipal Contacts for Code 35 Revisions

Article ID: 240, Created On: 3/12/2015, Modified: 10/28/2015

Feedback (0)