The Department of Health (DOH) Bureau of Early Intervention
(BEI) has approved the State Fiscal Agent (SFA) to reimburse providers for open
service coordination services claims denied by Medicaid due to the “Code 35”
restriction. Claims selected for reimbursement will meet the following two criteria:
- Early
Intervention service coordination claims received by EI Billing through September
30, 2015
- Service coordination
services claims remain unpaid and in a Code 35 Medicaid denial status
Payment of these claims will be funded by municipalities
through their Early Intervention (EI) escrow accounts and processed by the SFA.
A claim-level detail report, including the total dollar amount for service
coordination services that will be disbursed from escrow will be provided to
each municipality. During the week of February 29, 2016, a special invoice that
includes the amount owed to cover these claims will be sent to the municipality.
The municipal special invoice is based on estimated figures – the actual amount
may be slightly less than the estimate. Distribution of the invoice occurred
through the normal invoicing process.
The SFA will issue payment to providers for these claims on Thursday,
March 17. This payment will be issued as a special check run and will be
executed prior to the regular check run during that week. Municipalities are
requested to deposit funds to support the payment of the special invoice no
later than Friday, March 11.
Please note that in addition to this special invoice,
municipalities are still required to meet their obligation to fund the escrow
account for EI claims currently being submitted and processed.
The Department is committed to ensuring service coordination
services claims for Medicaid children are reimbursed through the Medicaid
program. The SFA will continue to pursue Medicaid reimbursement for service
coordination services claims and adjustments will be made to provider payments
as Medicaid payments are received for these claims.
If you have any questions, please call the PCG Customer Service
Center at (866) 315-3747.