EI Billing Providers:

This is a reminder to all EI Billing Providers on annual Medicaid recertification. The SFA sends a communication to each EI Billing Provider in advance of their Medicaid decertification date each year. It is important that providers submit their annual Medicaid recertification forms prior to their Medicaid decertification date each year. Failing to recertify prior to your Medicaid decertification date may lead to:

·         Medicaid claims processing and payment delays

·         Receipt of Medicaid paper remittance (EOBs) which must be manually posted by the SFA

The SFA will continue to inform EI Billing Providers when they must recertify each year. It is essential that providers recertify in a timely manner to avoid the issues outlined above.

Please Note: When recertifying for Medicaid, providers must enter a current certification date on the form as Medicaid cannot process a recertification form with a date more than 11 months in past or 50 days in future.

Medicaid Recertification vs. Medicaid Revalidation: Medicaid recertification (Form #490601) must be completed annually under in order to submit EI claims electronically to Medicaid. Medicaid revalidation (Form #436601) is mandated under the Affordable Care Act (ACA) and must be completed by Medicaid providers every five years. Revalidation includes providing information on the provider’s ownership, managing employees, agents, persons with a control interest, as well as providing current addresses, specialties, etc. Even if you have already revalidated, you must still recertify for Medicaid annually.

If you have any questions, please contact the PCG Customer Service Center at (866) 315-3747.