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Medicaid Service Coordination Management - UPDATE

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

Medicaid Service Coordination Management

UPDATE


Subject: Updated Municipal Contacts and an Alternative Way to Send Medicaid Service Coordination/Case Management Enrollment/Disenrollment Form to NYSoH (Health Exchange)

Date: December 15, 2015

Purpose: This announcement replaces the Listserv item sent March 25, 2015. Below and attached you will find an updated Municipal Contacts for Code 35 Revisions and an alternative way to send information to NYSoH (Health Exchange) for reimbursement for service coordination (SC) services delivered under the Early Intervention Program (EIP).

Dear Colleague: 

An updated Municipal Contacts for Code 35 Revisions is attached. In addition, this same document includes an alternative way of sending the Exception Code 35: Case Management Change Form to NYSoH (Health Exchange) using the Health Commerce System (HCS) Secure File Transfer.

How to Access and Use the HCS Secure File Transfer

The Secure File Transfer is a secure and easy way to transfer files, up to 100 megabytes in size, from one HCS user to another. It is secure, because the file is not e-mailed, rather the file resides on the HCS until it is downloaded.

To access the HCS Secure File Transfer :

  • Log on https://commerce.health.state.ny.us 
  • Click My Content towards the top of the page, Choose All Applications. From the list, find Secure File Transfer Application.” Click on the “+” sign to add this application to your list of “My Applications” on the left. Secure File Transfer will now show up under your “My Applications” list whenever you log on to the HCS. You click on the words “Secure File Transfer” to open the application
  • Once within Secure File Transfer (SFT), click on “Send someone else a file” located in the “I want to…” section.
  • Enter the NYSoH User ID in the “Mail to User” field. Then click on the first “Browse” button and choose your attachment. If desired, you may include comments in the “Comments” field. When everything is set, click the “Upload” button to send your completed roster to the Department of Health. You will receive an e-mail when the roster is received by the Department. 
  • An e-mail message is sent to the intended recipient notifying them to go to the HCS to download the file(s). The recipient can click the link in the e-mail, copy and paste the link into their browser address window, OR go directly to the “Retrieve a file someone has sent me” of the SFT Application to retrieve the file(s). The recipient is the ONLY person who can access this page and/or file. The sender is notified, by e-mail, when the recipient downloads the file. 

Announcement Sent March 25, 2015

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 (Updated December 1, 2015)

Article ID: 304, Created On: 12/16/2015, Modified: 12/16/2015

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