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 September 1, 2019 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for children no longer active in the Early Intervention Program (EIP).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 September
1, 2019 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.
During the week
of November 25, 2019, PCG will send an invoice to each municipality for these
claims. The invoice is due the week of December
2, 2019, and PCG will complete the escrow payout during the week of December
9. This process will be identical to how special payments have been handled
previously.
If you have any
questions, please contact the PCG Customer Service Center at (866) 315-3747.
Article ID: 414, Created On: 11/25/2019, Modified: 11/25/2019