New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List
Early Intervention Program Progress Report – Excellus
Dear
Colleague:
The Department is pleased to report that substantive progress has been made in
ensuring that insurance payments from Excellus Health Plan are issued directly
to EIP billing providers and claims adjudication information is directed to the
Department’s interim fiscal agent, James McGuinness Associates
(McGuinness).
Beginning Friday, September 6, 2013, Excellus has implemented technical changes
to its claims processing systems that will ensure that EIP claims are
recognized, payments are appropriately issued to the EIP billing provider, and
remittance advices with claims adjudication information is sent to
McGuinness. This change will substantially improve the timeliness of EIP
claims processing and payment to EIP providers from Excellus Health
Plan.
Excellus Health Plan includes Excellus BlueCross BlueShield and Univera
Healthcare. Excellus BlueCross BlueShield covers the following counties:
Monroe; Wayne; Livingston; Seneca; Yates; Ontario; Steuben; Schuyler; Chemung;
Tioga; Tompkins; Cortland; Broome; Cayuga; Onondaga; Oswego; Chenango; Madison;
Delaware; Otsego; Herkimer; Montgomery; Fulton; Oneida; Lewis; Hamilton; Essex;
Clinton; Franklin; St. Lawrence; and Jefferson. Univera Healthcare covers the
following counties: Allegany; Cattaraugus; Chautauqua; Erie; Genesee; Niagara;
Orleans; and Wyoming. Please note some of the other Bluecross Blueshield
plans that are not part of Excellus also provide coverage to some of these
counties, so they are not exclusively Excellus counties. EIP providers doing
business in these counties will begin to see improvements in Excellus Health
Plan claims processing as early as mid-September.
Excellus
Health Plan does not include the following entities: Empire BlueCross
BlueShield, Blue Cross and Blue Shield of Western New York, and Blue Shield of
Northeastern New York. The Department continues to work with these and
other companies to implement similar solutions to ensure payments are appropriately
made to EIP providers and remittance advices are issued to the Department’s
fiscal agent.
The
following actions are being taken by Excellus Health Plan to address issues
with EIP claims submitted prior to September 6, 2013:
Excellus
Health Plan has provided reports to McGuinness detailing EIP claims
adjudication results for claims submitted April 1 through September 5, 2013, to
allow McGuinness to complete the processing of these claims and work with
providers to resolve outstanding issues on incomplete or inaccurate
claims. Providers should begin receiving payments from the county funded
escrow account for these adjudicated claims beginning this week.
Excellus
Health Plan is issuing a letter to all EIP parents who are members of Excellus
Plan and who received a misdirected check for early intervention
services. This letter, which is enclosed and was sent to parents Friday,
September 6, 2013, instructs parents who have cashed a check to pay their EIP
providers and give the EI provider a copy of the explanation of benefits
included with the check. The letter instructs parents who have not cashed
the check to sign it and give it to the provider. Excellus Health Plan
and the Department are issuing the enclosed letter to EIP providers instructing
them to accept checks and payments from families. If a family is not open
to reissuing payment to the EIP provider, or if the EIP provider prefers to
directly work with Excellus for reissuance of payment, a representative of
Excellus will assist the provider in securing reissuance of the payment.
Thank You
Please note, the following attachments were included on this email from the BEI: