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and denied for coordination of benefits (CO-22) for children no longer active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
was 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 EI 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 program and have an inactive
IFSP
Claims with a Medicaid CO-22 denial
that meet either of these criteria will be paid out of escrow. Payment of these
claims through the escrow account will ensure the claims can be included in the
Medicaid retroactive claiming process.
PCG will send an invoice to each
municipality for these claims. The invoice is due on July 21, 2016, and PCG will complete the escrow payout on July 28.
This process will be identical to how special payments have been handled
previously.
If you have any questions, please
contact the PCG Customer Services Center at (866) 315-3747.
Article ID: 331, Created On: 7/10/2016, Modified: 7/10/2016