The Bureau of Early Intervention (BEI), with
the assistance of PCG, will be taking steps to pay EI Billing Providers for
claims submitted to Medicaid for the period April 1, 2013 to October 31, 2015 and
denied for coordination of benefits (CO-22) for children no longer active in
the Early Intervention Program (EIP). The basis for this denial is the child is
covered by commercial insurance that was unknown to the EIP and not billed as
required prior to submission of claims to Medicaid. BEI recognizes that EIP Providers
cannot address missing commercial insurance information in situations where a
child’s case is closed. For a child to be deemed inactive in the EIP for the
purposes of these payments, the child must either:
- Have turned three (3) years of age on or before July 1, 2015 and
are no longer age-eligible for EIP; or
- Be closed from the EIP and have an inactive IFSP
Claims with a Medicaid CO-22 denial that meet
either of these criteria will be paid out of escrow.
Please note that prior to invoicing the
counties for these claims, PCG will resubmit ALL claims with a Medicaid CO-22
denial to Medicaid for adjudication. This
will ensure claims with a CO-22 denial for children whose insurance information
was subsequently added and adjudicated by the commercial payer to be paid by
Medicaid.
PCG will be resubmitting all CO-22 claims
during the week of January 11, 2016, and will complete the escrow payout during
the week of January 25, 2016. Providers can check their Medicaid CO-22 denials
in “Medicaid Claims Needing Attention” in EI Billing.
It is the Department’s expectation that EI
providers will continue to work with service coordinators and municipalities to
actively pursue commercial insurance information for children actively enrolled
in the EIP.
If you have any questions, please contact the
PCG Customer Services Center at (866) 315-3747.