New York State
Department of Health
Bureau of Early Intervention Electronic Mailing List
Responses to Additional Questions on Provider Billing and Claiming Beginning
April 1, 2013
Dear
Colleagues:
The following are responses to additional questions received regarding
submission of provider bills and claims to commercial insurance and the
Medicaid Program beginning April 1, 2013.
1. What
billing and payment information will be given to providers for children they
serve who have coverage under an insurance policy or Medicaid?"
As a
reminder, providers will be paid directly by commercial insurers and the
Medicaid Program. The remittance advices will be sent to the interim State
Fiscal Agent to allow the SFA to track commercial insurance and Medicaid
payments, assist providers in responding to requests for additional or
corrected information from third party payors as needed to adjudicate payable
claims, and determine amounts owed to providers for partially-paid or denied
claims.
As indicated
in the March 22, 2013 email regarding responses to questions on provider
billing and claiming beginning April 1, 2013, providers will eventually have
access to billing and claiming status reports for early intervention services
rendered to all children, regardless of whether child records are in KIDS or in
NYEIS, via first the interim SFA’s secure website and subsequently the final
SFA.
2. Question: When will the Department announce the interim and final
state fiscal agent contractors?
We will
provide more info on the interim State Fiscal Agent and entity awarded the
State Fiscal Agent contract shortly.
3. If a provider has not been enrolled in the Medicaid Program as a
billing provider by April 1, 2013, can the provider continue to provide
services to children enrolled in Medicaid?
Response:
Yes. However, it is important to note that providers who are not
currently enrolled in the Medicaid Program must submit completed
enrollment forms to the Medicaid Program as soon as possible to ensure an
effective enrollment date of April 1, 2013, to be able to bill for services
provided on and after that date.
If the
EIP provider has completed the necessary forms, no further action is needed.
The EIP provider will receive a letter from the Medicaid Program with the
assigned provider ID in the near future.
If the
EIP provider has questions about the provider's status in the Medicaid Program,
please send an inquiry to the following email address:
rbu@health.state.ny.us.
=========================================================
DETERMINE WHETHER YOUR CIRCUMSTANCES FIT #1 OR #2 AND FOLLOW ONLY THOSE DIRECTIONS
#1 - Never enrolled in Medicaid as an EIP Provider:
Attached is information and instructions for enrollment in the Medicaid Program
for those EIP providers who are not enrolled in the Medicaid Program for EIP.
Following is
a link to the enrollment form and additional instructions mentioned in the
information document: Letter New EI Provider_Never_ Medicaid enrolled 3.12.pdf.
https://www.emedny.org/info/ProviderEnrollment/cmcm/Option2.aspx.
#2 -
Enrolled in Medicaid as a non-Billing EIP Provider:
If an EIP provider is currently enrolled in the Medicaid Program as a
non-billing provider, the EIP provider is only required to submit a disclosure
form. The Letter EI Provider Medicaid enrolled 3.12.pdf and Disclosure of
Ownership & Control.docx are attached.
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Attachments:
Disclosure of Ownership & Control.docx
New EI Provider_Never_ Medicaid enrolled 3.12.pdf
EI Provider Medicaid enrolled 3.12.pdf