New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List
Subrogation Notices – New Functionality on EIBIlling.com
Dear Colleague:
Pursuant to NYS Public Health
Law (PHL) § 2559(3)(d), approved early intervention providers are subrogated to
the rights an eligible child and his or her family may have or be entitled to
from an insurer or health maintenance organization for services rendered by
providers to the child and family that are covered under an insurance policy,
plan or benefit package. Providers must submit notice to the insurer or plan
administrator of their exercise of the right of subrogation upon the provider's
assignment as the early intervention service provider for the child. NYS
Insurance Law § 3235-a(c) states that a right of subrogation exercised by a
provider under PHL § 2559 is valid and enforceable against the insurer or
health maintenance organization to the extent benefits are available under the
insurance policy, plan or benefit package. The insurer or plan administrator
must accept claims from an approved early intervention provider who has
submitted prior written notice of intent to exercise subrogation rights for any
early intervention services for which benefits are available to the insured
child.
The Department’s interim
fiscal agent, James McGuinness and Associates (McGuinness), has enhanced the
functionality on its website, www.EIBilling.com, to enable providers to print
subrogation notices, using the Department’s template, populated with children’s
insurance information, for children: (1) to whom the provider is rendering
services, and (2) either the child’s insurance coverage has been identified in
NYEIS as subject to State insurance law OR parent consent has been
provided to bill insurance, if the child’s and family’s insurance policy is NOT
subject to state insurance law.
This functionality is
immediately available for any child for whom the provider submitted bills in
NYEIS during the first three weeks of April. By close of business today,
Thursday, May 9, 2013, this functionality will be available for ALL children
whose records reside in NYEIS.
For children whose records
reside in the KIDS legacy system, insurance information will become available
to populate the template as counties upload bills for children enrolled in KIDS
and transmit files to McGuinness for claiming and payment purposes. In
addition, McGuinness has obtained insurance information for ALL children whose
records reside in KIDS from the following counties: Schenectady, Orange,
Rockland, and Suffolk. McGuinness is currently working with Westchester
and Nassau Counties to upload child insurance information from KIDS.
Please be reminded that
insurance policy information is pulled from NYEIS and KIDS data and may not
include all addresses associated with the child’s insurer. If an insurer
advises the provider to submit the subrogation notice to a different address, the
provider should follow instructions supplied by the insurer.
McGuinness will accept full
KIDS insurance data from any county. Counties should contact McGuinness
at CountySupport@EIBilling.com to obtain instructions to upload
child insurance data to McGuinness.
McGuinness is adding screens
into EIBilling.com to allow providers to view insurance information for
children for whom the provider has service authorizations. This
functionality will be available in EIBilling.com by tomorrow, Friday, May 10,
2013.
Thank you.
Subscription Information
To subscribe to this list, send an e-mail to nyeislist@health.state.ny.us with
"Subscribe" in the subject line and include your first and last name
in the body of the e-mail. BEI will add your e-mail address to the mailing
list. If you have received this e-mail from the Bureau of Early Intervention
NYEIS Electronic Mailing List (NYEIS-L), you are already subscribed. Please do
not send an additional request.
To unsubscribe from the list, send an e-mail to nyeislist@health.state.ny.us with
"Unsubscribe" in the subject line and your name in the body of the
e-mail.