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Provider 835 Enrollment

EI Billing Providers:

In an effort to continue to improve provider payment outcomes, the Bureau of Early Intervention (BEI) and the State Fiscal Agent (SFA) – PCG – encourage all Early Intervention (EI) Billing Providers to receive electronic remittance information via the 835 process.

In January 2015, the SFA and BEI introduced this process to streamline the receipt of electronic remittance data for EI Providers. The process allows payers to electronically send insurance remittance data in a HIPAA-compliant 835 format via Emdeon[1] to the SFA.

BEI and the SFA initiated the transition to the 835 process due to a multitude of benefits, including the following:

·         Shorter Payment Cycle – Receiving remittance data electronically shortens the lifecycle of a claim, by allowing the SFA to receive remittance data more quickly

·         Reduction in Administrative Burden – Reduces manual work by eliminating the need for EI Providers to enter remittance data directly into EI Billing or send remittance data to the SFA for processing

·         Data Accuracy and Completeness – Allows the SFA to receive more detailed information, which stands up to scrutiny and protects the Provider

·         Reduction in Denials – Helps prevent subsequent denials based on untimely claims resubmissions

·         Industry Standard – The receipt of insurance remittance data via an 835 is a HIPAA-compliant industry standard practice

BEI and the SFA agree that 835 is the most efficient, effective and secure way for EI Providers to receive remittance data.  It takes approximately 4-6 weeks for a payer to complete the 835 enrollment process; therefore, BEI and the SFA urge EI Billing Providers to begin enrollment as soon as possible. Following the transition to 835 process, the manual entry of EOBs will be discontinued for all EI Billing Providers.

Please note: For EI Billing Providers that only serve EI or Pre-school children, the SFA will provide via email pre-filled enrollment forms for the payers that you or your organization are currently billing.

For EI Billing Providers that have lines of business other than EI, 835 enrollment requires a separate and distinct NPI for your EI line of business. If you do not already have a separate NPI for EI, you will need to create one prior to beginning the 835 enrollment (Apply for an NPI via NPPES). Once obtaining a separate NPI for your EI line of business, you or your organization must ensure that the NPI matches the NPI used to enroll in Medicaid as an EI provider and is associated with the SFA ETIN.  Please visit the EI Billing Knowledge Base for more information on this process or contact the PCG Customer Service Center at (866) 315-3747.

[1] Electronic Clearinghouse for insurance claims data

Article ID: 291, Created On: 11/11/2015, Modified: 11/11/2015

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