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Early Intervention Program Covered Lives legislation (A.5339/S.5560A) - FAQ Added

Early Intervention Program Covered Lives legislation (A.5339/S.5560A)


On December 29, 2021, Governor Hochul signed legislation (A.5339/S.5560A) that significantly changes the way claims for Early Intervention services will be processed and paid. The legislation establishes an Early Intervention Program (EIP) covered lives pool funded by an assessment on insurance plans. The EIP pool funding will offset the municipal and State share of EIP services not covered by Medicaid. EIP claims will no longer be billed to commercial insurance. Claims will continue to be billed to Medicaid for covered services and to municipal escrow for non-covered services.


The grid below outlines how claims with a date of service on or after 1/1/2022 will be processed and paid based on implementation of the covered lives legislation.


Scenario

Claim Process

Commercial Insurance Only

Claims will be sent to escrow for payment.

 

Commercial Insurance and Medicaid

If the service is Special Instruction or Service Coordination, claims will bypass CI and be sent to Medicaid.

 

For all other services, the claim will bypass both CI and Medicaid and be sent to escrow for payment.

Medicaid or Medicaid Managed Care Only

Claims will be sent to Medicaid for payment.    

Any Medicaid claim which denies for coordination of benefits (CO22) will be moved to escrow. 

No coverage

Claims will be sent to escrow for payment.

 

This change in legislation will also impact how EIP Providers process their claims in EI Billing. When working in their queue, Providers should address any new or outstanding commercial insurance claims as follows:

  • Any claims (including commercial and non-commercial claims) with a date of service prior to 1/1/2022 should be processed by the Provider as normal.
  • Commercial claims with a date of service on or after 1/1/2022 do not need to be processed by the provider and can remain in your queue. These claims will be managed by Public Consulting Group (PCG). By March 31, 2022, PCG will perform a review of all claims in a provider’s queue. Any commercial claims identified during this review will be processed based on the covered lives legislation. Once processed, these claims will then be moved to escrow for payment.
  • Any commercial insurance claims that were paid for services provided on or after 1/1/2022, will be voided in EI Billing. Once voided, the claims will be moved to escrow. Payers may request reimbursement of voided claims directly from the EIP Provider. This is determination is made by the Payer.

If I have additional questions or need further information who should I contact? 

Please click the link below to view an infographic and set of Frequently Asked Questions (FAQs) on the Covered Lives implementation:


Covered Lives Infographic and FAQ


If you have additional questions after carefully reviewing this article, contact the PCG Customer Service Call Center at (866) 315-3747.

Article ID: 465, Created On: 2/24/2022, Modified: 3/16/2022

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