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 March
31, 2016
- 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. On September 14, 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, September 29. This payment will be issued as a special check run and
will be executed after 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, September 23.
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.