IFA Processing of Claims - General Overview

For children enrolled in NYEIS, the process is very similar to how it has been. Follow the right side of the accompanying chart. As a provider, continue to submit your claims to NYEIS. The system will run Edit Checks to verify the claims are valid. (Edit checks consist of a set a questions: are there enough units left, is the information provided for this claim valid, is this a valid CPT code, etc.) Once the claims have passed the Edit Checks in NYEIS, NYEIS will forward all of the valid claims to the Interim Fiscal Agent to process through their Fiscal Administration System. At this point, the Fiscal Administration System will manage submitting the claims to Commercial Insurance, submitting claims to Medicaid, and retrieving any remaining balance from the statewide Escrow Account.

The left hand side of the chart shows the process for children enrolled in KIDS. First, service records must be submitted to the EIBilling.com website. The counties will then run these records through KIDS to perform the Edit Checks. These Edit Checks are very similar to the Edit Checks run for the children enrolled in NYEIS. Once the claims have passed the Edit Checks in KIDS, KIDS will upload the valid claims to the Fiscal Administration System for the Interim Fiscal Agent to take over and process the claims.