New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List
Medicaid Managed Care and EI Billing
Dear
Colleague:
This e-mail provides important information regarding children enrolled in a New
York State Medicaid Managed Care Plan. It has been brought to the Department’s
attention that numerous claims for children enrolled in Medicaid Managed Care
Plans for their health care coverage were billed to the Managed Care plan in
error, because the child’s health insurance information was incorrectly
recorded in KIDS or NYEIS as a commercial insurance product.
For purposes
of the Medicaid Program, early intervention services are not included as part
of the Medicaid Managed Care Plan benefits package. Medicaid Managed Care
Plans must not be billed for EIP services. Rather, early intervention
services are paid for using the fee for service system and are billed to the
Medicaid Program using the child’s Medicaid client identification number (CIN)
and reimbursed to the provider at Department established rates.
It is very
important that children in the Medicaid Program are identified as Medicaid
enrollees in Medicaid Managed Care Plans, and CINs are included in NYEIS.
This information must be recorded correctly in KIDS or NYEIS in order for
claims to be routed appropriately to Medicaid.
The
Department has worked with the interim State Fiscal Agent (SFA) to identify
currently affected claims that were incorrectly billed to Medicaid Managed Care
Plans based on the wrong data in KIDS or NYEIS (21,000 claims totaling
$1,679,893.00) that have now been withdrawn and resubmitted to the Medicaid
fee-for-service system. The SFA utilized data obtained from the Medicaid
Program to temporarily flag a child’s Medicaid Managed Care Plan as
non-billable in EI Billing. Any claim outstanding to commercial insurance where
the child also has an active Medicaid CIN recorded was transmitted to Medicaid
on Wednesday, August 28 (Medicaid cycle 1880). Providers may soon begin to
receive payments or responses requesting additional information from the
Medicaid Program regarding these claims. No explanation of benefits (EOB)
details need to be recorded for the commercial insurance claims in EI Billing
as the SFA will manually mark these claims as denied. The SFA will also notify
the insurers to inform them that these claims can be disregarded as they were
submitted in error.
Claims that
are impacted by this issue have been identified from providers in the following
counties: Albany, Broome, Cattaraugus, Chautauqua, Chenango, Clinton,
Cortland, Dutchess, Erie, Essex, Greene, Herkimer, Lewis, Monroe, Nassau, New
York, Niagara, Oneida, Onondaga, Orange, Otsego, Putnam, Rensselaer, Rockland,
Saratoga, Schenectady, Schoharie, Seneca, Steuben, Suffolk, Sullivan, Tompkins,
Ulster, Warren, Washington, Westchester, Wyoming. Providers in other
counties are not impacted.
Service
coordinators are responsible for collecting and updating a child’s insurance
information on an ongoing basis. Service coordinators and municipalities must
work together to correctly identify each child’s policy information in KIDS or
NYEIS as soon as possible to prevent future claims from being inappropriately
billed to the Medicaid Managed Care plan. It is critical that service
coordinators and municipalities work together with families to determine the
appropriate status of a child’s insurance and/or Medicaid coverage. In nearly
all municipalities, once a child is determined to be eligible for Medicaid,
they are required to enroll in a Medicaid Managed Care Plan. For more
information about enrollment, exclusions, or general information on Managed
Care, please visit the NYS Department of Health Managed Care website at http://www.health.ny.gov/health_care/managed_care/index.htm
or call the Medicaid Managed Care helpline at 1-800-505-5678.
A
spreadsheet outlining the affected children has been created and is being sent
via the Health Commerce System (HCS) Secure File Transfer (SFT) to Early
Intervention Officials so that they can correct these records in the source
data system. Please note that not all municipalities will receive a
spreadsheet. The spreadsheet notes child information, child CIN, insurance
recorded in systems, Medicaid Managed Care (MMC) insurer information from
Medicaid, and data source (NYEIS/KIDS). The child must have a MA CIN recorded
in order for claims to be billed to MA. Municipalities and service coordinators
must review and determine if the insurer listed in the source data system is in
fact a MMC insurer.
To resolve
these errors for children enrolled in KIDS, the municipality must edit the
commercial plan recorded in the child’s record and mark as “Do Not Bill”. This
can be completed under the Other Tab, selecting private insurance, browsing to
the MMC insurer, selecting the Set Billing Control and checking the “Do NOT use
for EI Billing” box. If asked if you want to update bill’s insurance status,
select Yes.
To resolve
these errors for children enrolled in NYEIS the municipality or child’s service
coordinator have the access rights to make this change. The user can view the
child’s insurance information by selecting the Insurance Coverage link on the
Child’s Homepage, selecting edit for the MMC insurer, and selecting the Yes
dropdown in the “Is Plan Medicaid Managed Care?” field.
This data
must be updated as soon as possible to prevent future claims from being sent to
the MMC insurer. It is critical that service coordinators and municipalities
work together with families to determine the appropriate status of a child’s
insurance and/or Medicaid coverage.
Thank you for
your attention to this important priority and data correction project.
Please note
these additional resources for questions:
Questions regarding EI Billing: 1-866-315-3747 Monday-Friday 7am-7pm
Questions regarding NYEIS: nyeis@cma.com
Questions regarding KIDS: kids@health.state.ny.us
Questions for the Bureau of Early Intervention: bei@health.state.ny.us
Please
do not respond to this e-mail announcement.
Thank You.