The Bureau of Early Intervention (BEI) Early Intervention Program (EIP) regulations adopted December 5, 2018 limit the submission of EI claims to 90 calendar days after the date of service (excluding extraordinary circumstances). BEI, with the assistance of PCG, the State Fiscal Agent (SFA), implemented the amended regulations for dates of service starting February 10, 2019.

Amended Regulations

The EIP regulations at 10 NYCRR Section 69-4.22(a)(4) state the following:

• 90-Day Deadline. EI Providers must submit all claims within 90 calendar days of the date of service, unless submission is delayed by extraordinary circumstances documented by the provider and acknowledged by the SFA
• Extraordinary Circumstances Deadline. Claims submitted after 90 days due to an extraordinary circumstance shall be submitted within 30 days from the time the EI Provider was relieved from the extraordinary circumstance
• No Reimbursement for Late Claims. Claims not submitted within these timeframes will not be reimbursed by the SFA from the escrow account

New EI Billing Process

To accommodate these regulations, there are some changes in the EI Billing claims submission process, depending on when you submit a claim:

Claims submitted PRIOR to 90-day deadline – There will be NO CHANGE in the process for any claims submitted to NYEIS within the 90 calendar day timeframe following the date of service.

Claims submitted AFTER 90-day deadline (WITH extraordinary circumstance) – Will require the entry of the extraordinary circumstance in EIBilling and changes to reports. PCG will offer webinar training regarding EIBilling changes. Providers will be required to keep all documentation for this extraordinary circumstance on record.   

EI Billing will acknowledge receipt of the extraordinary circumstance, and verify the dates with the claims submitted via NYEIS. If the claim is a match, it will be processed as a normal claim.

Claims submitted AFTER 90-day deadline (WITHOUT extraordinary circumstance) –Claims entered in NYEIS after the 90-day deadline without a recorded extraordinary circumstance in EI Billing will not be processed for payment by escrow. Claims submitted past the 90-day submission deadline will be submitted to Medicaid or commercial insurance for adjudication as applicable. There will be a “late claim adjustment” column added to EI Billing reports to reflect any amount that was not paid by escrow due to late filing.

Extraordinary Circumstances

The following are extraordinary circumstances under which BEI would consider paying claims submitted more than 90 days after the date of service. Guidance related to each circumstance will be included in SFA training material, accessible on EIBilling.com:

• Natural Disaster
• State Administrative Delay
• Audit Findings
• Litigation
• Death of Essential Personnel

Hospitalization of Essential Personnel

Entering Extraordinary Circumstances on EIBilling.com

When an extraordinary circumstance occurs, the provider should work to ensure that claiming resumes as quickly as possible. Once the circumstance is resolved (date of relief), the provider must enter the extraordinary circumstance into EI Billing within 30 days. Follow these steps:

1.     Login to EIBilling.com

2.     Click on the ‘Claiming’ tab, scroll over ‘Timely Filing’, and click ‘Enter Extraordinary Circumstance’

3.     Select the type of extraordinary circumstance from the drop-down and confirm

4.     Enter a detailed description of the extraordinary circumstance

5.     Enter a date of event (when the extraordinary circumstance occurred) and confirm

6.     Enter a date of relief (when the extraordinary circumstance ended) and confirm

7.     Click ‘Generate Form’ and print the form

8.     Check the box to confirm that the form printed, and the information is correct

9.     Click ‘Submit’

10.  On the acknowledgement page, check the box to acknowledge that you have read the statement and will maintain records regarding the extraordinary circumstance

11.  Click ‘Print Acknowledgement’

Retain both the Extraordinary Circumstance Form and Acknowledgement, and any records related to the extraordinary circumstance in accordance with EIP guidance on retention of Early Intervention Program records.

Questions or Concerns?

Click here for a Question and Answer document on the 90-Day Claims Submission Deadline.

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