New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List
Medicaid Service Coordination Management
Subject:
Service Coordination/Case Management Enrollment/Disenrollment Form with
Instructions
Date: March
25, 2015
Purpose: Provide information and a standardized form for the assignment of the
Medicaid Exception Code 35 which allows for Medicaid reimbursement for service
coordination (SC) services delivered by the Early Intervention Program (EIP).
Under
Medicaid only one billing provider may be reimbursed for a child’s SC services
at a given time. The Medicaid Exception Code 35 identifies the SC provider. In
order for reimbursement to be claimed for EI SC services the Local Department
of Social Services (LDSS) in the child’s transaction district (most often the
county in which the child resides) or the Bureau of Medicaid Enrollment and
Exchange Integration (NYSoH), must combine the child’s Code 35
Restriction/Exception Subsystem with the billing provider’s Medicaid Provider
Identification number in the Welfare Management System or eMedNY (electronic
Medicaid system). This code has no effect on any of the other services that a
Medicaid eligible child needs.
To assist
the LDSSs/NYSoH and EI SC providers with the enrollment/disenrollment process
the Bureau of Early Intervention and the Bureau of Medicaid Enrollment and
Exchange Integration are providing a suggested form (Exception Code 35: Case
Management Change Form), plus associated instruction sheets. This form was modeled
after similar forms currently being used. Do not combine enrollment and
disenrollments. Use separate forms for each type of request.
It is our
hope that the suggested form will help to ensure accurate Code 35 assignments
in a timely manner.
If you have
questions please contact the Bureau of Early Intervention by emailing beipub@health.ny.gov.
Additional
Guidance:
- Code
35s must be entered and removed from a child’s Medicaid record. The
attached form can be used to manage both. Please do not mix the Type of
Request, rather use a separate form for each type.
- As
a reminder if you are no longer providing SC to a child you must disenroll
them so that they can be assigned to a new SC provider
- Enrollment/disenrollment
dates must match the correct start and end dates associated with the
provider’s SC service authorization for the child.
- As
part of the SC biller’s responsibility, they should develop a routine of
notifying the child’s transaction district when a Code 35 must be enrolled
or disenrolled. Requests for children enrolled through NYSoH Medicaid
(H78) are being handled by NYSoH Exceptions. See Exception Code 35: Case Management
Change Form (page two) or Municipal Contacts for Code 35 Revisions for
additional information.
Attachments:
Exception Code 35: Case Management Change Form
Municipal Contacts for Code 35 Revisions