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 April 30, 2016 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no longer active in the Early Intervention Program (EIP).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 January
1, 2016 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.
PCG will complete the escrow payout
on July 28, 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: 330, Created On: 7/10/2016, Modified: 7/10/2016