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CO-22 Payment Provider Notice - January 2016

The Bureau of Early Intervention (BEI), with the assistance of PCG, will be taking steps to pay EI Billing Providers for claims submitted to Medicaid for the period April 1, 2013 to October 31, 2015 and denied for coordination of benefits (CO-22) for children no longer active in the Early Intervention Program (EIP). The basis for this denial is the child is covered by commercial insurance that was unknown to the EIP and not billed as required prior to submission of claims to Medicaid. BEI recognizes that EIP Providers cannot address missing commercial insurance information in situations where a child’s case is closed. For a child to be deemed inactive in the EIP for the purposes of these payments, the child must either:

  • Have turned three (3) years of age on or before July 1, 2015 and are no longer age-eligible for EIP; or
  • Be closed from the EIP and have an inactive IFSP

Claims with a Medicaid CO-22 denial that meet either of these criteria will be paid out of escrow.  

Please note that prior to invoicing the counties for these claims, PCG will resubmit ALL claims with a Medicaid CO-22 denial to Medicaid for adjudication.  This will ensure claims with a CO-22 denial for children whose insurance information was subsequently added and adjudicated by the commercial payer to be paid by Medicaid.

PCG will be resubmitting all CO-22 claims during the week of January 11, 2016, and will complete the escrow payout during the week of January 25, 2016. Providers can check their Medicaid CO-22 denials in “Medicaid Claims Needing Attention” in EI Billing.

It is the Department’s expectation that EI providers will continue to work with service coordinators and municipalities to actively pursue commercial insurance information for children actively enrolled in the EIP.

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


Article ID: 306, Created On: 1/12/2016, Modified: 1/12/2016

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