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Code 35 Claims Payment Notice to Municipalities - June 2016

The Department of Health (DOH) Bureau of Early Intervention (BEI) has approved the State Fiscal Agent (SFA) to reimburse providers for open service coordination services claims denied by Medicaid due to the “Code 35” restriction. Claims selected for reimbursement will meet the following two criteria:

  • Early Intervention service coordination claims received by EI Billing through December 31, 2015
  • Service coordination services claims remain unpaid and in a Code 35 Medicaid denial status

Payment of these claims will be funded by municipalities through their Early Intervention (EI) escrow accounts and processed by the SFA. A claim-level detail report, including the total dollar amount for service coordination services that will be disbursed from escrow will be provided to each municipality. During the week of June 6, 2016, a special invoice that includes the amount owed to cover these claims will be sent to the municipality. The municipal special invoice is based on estimated figures – the actual amount may be slightly less than the estimate. Distribution of the invoice occurred through the normal invoicing process.

The SFA will issue payment to providers for these claims on Thursday, June 30. This payment will be issued as a special check run and will be executed prior to the regular check run during that week. Municipalities are requested to deposit funds to support the payment of the special invoice no later than Friday, June 24.

Please note that in addition to this special invoice, municipalities are still required to meet their obligation to fund the escrow account for EI claims currently being submitted and processed.

The Department is committed to ensuring service coordination services claims for Medicaid children are reimbursed through the Medicaid program. The SFA will continue to pursue Medicaid reimbursement for service coordination services claims and adjustments will be made to provider payments as Medicaid payments are received for these claims.

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

Article ID: 326, Created On: 6/6/2016, Modified: 6/6/2016

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