This communication serves to follow up on previous guidance on entering EOBs, posted on EIBilling.com. PCG, as the State Fiscal Agent (SFA), receives and processes remittance information for claims billed to commercial insurance before those claims are able to move forward to be billed to Medicaid or the Escrow account. Although the SFA receives remittance information directly from most commercial insurance companies, providers may provide remittance information directly into the system.
There are two ways for providers to provide this remittance information: by faxing an Explanation of Benefits (EOB) to PCG for entry, or by manually entering an EOB. Below are brief descriptions of these two options for providing remittance information to the SFA.
PCG EOB Entry
PCG is happy to enter EOBs for providers. Providers that have not opted-out of this option may send remittance information directly to PCG for entry. There are two EOB Entry fax lines that you may use to submit EOBs for processing: 518-836-0456 OR 518-836-0500. Please fax each EOB only once – duplicate faxes increase processing time.
Current turnaround for processing resolved EOBs is approximately 3-5 business days. If your claims have not been processed after 5 business days, you may resubmit – please indicate as a resubmission and include the original submission date.
If a provider has opted-out of this option, they may opt back in at any time by sending an email to nyeibilling@pcgus.com.
Provider Manual Entry of EOBs
Providers that have opted out of PCG EOB Entry may enter their own EOBs through the EI Billing portal (Note: those that have not opted-out may also choose to manually enter EOBs*).
To enter EOBs directly into EIBilling.com, click "Claiming" in the menu, then drop down to click "Insurance," then click "Reporting EOBs." Providers can access step-by-step instructions for manually entering EOBs through EIBilling.com in this Knowledge Base article.
After successfully entering an EOB, a copy of the EOB should be faxed to PCG for audit purposes. There is a specific fax line for provider manually entered EOBs – that number is 518-836-0400. Please DO NOT fax an EOB manually entered by the provider to the PCG EOB Entry fax lines.
*Providers should only provide remittance information via ONE of the two available options – Provider manual entry or PCG entry.
If you have any questions, please contact the PCG Customer Services Center at (866) 315-3747.