Dear
Colleague:
Effective today, Early Intervention (EI) billing providers no longer have to
enter Explanation of Benefits (EOB) remittance data into the EIBilling system
for WellPoint, Oxford, Aetna and Fidelis. PCG, the State Fiscal Agent (SFA),
working with the Department of Health (DOH), Department of Financial Services
(DFS) and these four insurers, has created, tested and implemented a system of
receiving, loading and reporting remittance data for claims made by EI billing
providers for children covered by WellPoint, Oxford, Aetna and Fidelis. This
will improve the ability of providers to receive timely payments and reduce
manual data entry by providers.
Currently,
the SFA is receiving electronic remittance files from the following insurers,
which represents more than 66% of remittance for EI services. This represents
$30 Million in billed claims processed by the insurers in the chart below from
April 1, 2013 through February 28, 2014.
Insurers
Name
Percentage of Total Remittance Data
WellPoint
12%
Oxford
10%
Aetna
7%
Cigna
6%
Fidelis
3%
Excellus
6%
MVP
2%
DOH, DFS,
and SFA continue to work with other insurers to obtain, review and load
remittance data. PCG is currently receiving and reviewing remittance files from
other major insurers including, Affinity, Independent Health and Hudson Health
which totals 3.4% of remittance data. The SFA will provide updates on the
completion of those remittance processes as they occur.
WellPoint,
Oxford, Aetna and Fidelis have now built the capabilities to generate and send
the remit file to the SFA on a routine basis and the SFA is ready to accept and
post these files when received.
EI billing
providers will be able to review the remittance data for claims for services to
children covered by these insurers on EIBilling.com. Although not
recommended, to avoid duplicate data, providers will have the ability to
continue to enter remittance information for these insurers from paper EOBs via
EIBilling.com for a limited time.
The SFA also
wishes to remind providers that they no longer have to enter EOB remittance
data themselves into EIBilling.com. The SFA is providing manual entry of this
data to providers who wish to take advantage of this service. For more
information about how to take advantage of this service, please click here.
Should EI
billing providers have questions WellPoint, Oxford, Aetna and Fidelis
remittance data on EIBilling, they should contact the PCG Customer Services
Center at 1-866-315-37
Please do
not reply to this e-mail announcement.
Thank You.