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Responses to Additional Questions on Provider Billing and Claiming Beginning April 1, 2013

New York State Department of Health
Bureau of Early Intervention Electronic Mailing List

Responses to Additional Questions on Provider Billing and Claiming Beginning April 1, 2013

 


Dear Colleagues:

The following are responses to additional questions received regarding submission of provider bills and claims to commercial insurance and the Medicaid Program beginning April 1, 2013.  

1.   What billing and payment information will be given to providers for children they serve who have coverage under an insurance policy or Medicaid?"

As a reminder, providers will be paid directly by commercial insurers and the Medicaid Program. The remittance advices will be sent to the interim State Fiscal Agent to allow the SFA to track commercial insurance and Medicaid payments, assist providers in responding to requests for additional or corrected information from third party payors as needed to adjudicate payable claims, and determine amounts owed to providers for partially-paid or denied claims.

As indicated in the March 22, 2013 email regarding responses to questions on provider billing and claiming beginning April 1, 2013, providers will eventually have access to billing and claiming status reports for early intervention services rendered to all children, regardless of whether child records are in KIDS or in NYEIS, via first the interim SFA’s secure website and subsequently the final SFA.

2.   Question: When will the Department announce the interim and final state fiscal agent contractors?

We will provide more info on the interim State Fiscal Agent and entity awarded the State Fiscal Agent contract shortly.

3.   If a provider has not been enrolled in the Medicaid Program as a billing provider by April 1, 2013, can the provider continue to provide services to children enrolled in Medicaid?

 Response:  Yes. However, it is important to note that providers who are not currently enrolled in the Medicaid Program  must submit completed enrollment forms to the Medicaid Program as soon as possible to ensure an effective enrollment date of April 1, 2013, to be able to bill for services provided on and after that date.

 If the EIP provider has completed the necessary forms, no further action is needed.  The EIP provider will receive a letter from the Medicaid Program with the assigned provider ID in the near future.

 If the EIP provider has questions about the provider's status in the Medicaid Program, please send an inquiry to the following email address:

rbu@health.state.ny.us.

=========================================================

DETERMINE WHETHER YOUR CIRCUMSTANCES FIT #1 OR #2 AND FOLLOW ONLY THOSE DIRECTIONS
#1 - Never enrolled in Medicaid as an EIP Provider:  
Attached is information and instructions for enrollment in the Medicaid Program for those EIP providers who are not enrolled in the Medicaid Program for EIP.

Following is a link to the enrollment form and additional instructions mentioned in the information document: Letter New EI Provider_Never_ Medicaid enrolled 3.12.pdf.
https://www.emedny.org/info/ProviderEnrollment/cmcm/Option2.aspx.

#2 - Enrolled in Medicaid as a non-Billing EIP Provider:
If an EIP provider is currently enrolled in the Medicaid Program as a non-billing provider, the EIP provider is only required to submit a disclosure form. The Letter EI Provider Medicaid enrolled 3.12.pdf and Disclosure of Ownership & Control.docx are attached.


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Attachments:
Disclosure of Ownership & Control.docx
New EI Provider_Never_ Medicaid enrolled 3.12.pdf
EI Provider Medicaid enrolled 3.12.pdf

Article ID: 57, Created On: 5/8/2013, Modified: 10/28/2015

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