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2015 and denied for coordination of benefits (CO-22) for children no longer
active in the Early Intervention Program (EIP).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 was 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 EI 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 program and have an inactive IFSP
Claims with a Medicaid CO-22 denial
that meet either of these criteria will be paid out of escrow.
PCG will send each municipality an
estimate of the number, and total amount, of claims that meet the criterion
during the week of January 11, 2016. Municipalities can also view claims with
Medicaid CO-22 denials in EI Billing in “Medicaid Claims Needing Attention.”
Please note that prior to invoicing
municipalities 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 or
corrected and adjudicated by the commercial payer to be paid by Medicaid.
Payment of these claims through the escrow
account will ensure the claims can be included in the Medicaid retroactive
claiming process.
PCG will send an invoice to each
municipality during the week of January 11, 2016. This process will be
identical to how special payments have been handled previously.
If you have any questions, please
contact the PCG Customer Services Center at (866) 315-3747.