Providers can correct Medicaid claims that have been rejected for processing or denied for payment for workable problems on the Medicaid Claims Needing Attention page. The report is split into three tabs: "Category 1 - Problems detected by Fiscal Agent," "Category 2 - 277 Rejections," and "Category 3 - 835 Errors." Please note that each tab can be exported to Excel by clicking "Excel" at the bottom of the page.
To access this page, click "Claiming" in the EIBilling.com menu, drop down to click "Workable Claims," then click "Medicaid."
Category 1 - Problems detected by Fiscal AgentThe Medicaid Claims Needing Attention page has three tabs. The first tab, "Category 1 - Problems detected by Fiscal Agent," will list claims that the fiscal agent has determined have errors.
The "Errors" column will list the error. Click "Edit/Fix Claim" to make corrections to a claim, then "Fix it" in the pop-up window to resubmit the claim.
Please note that a delay reason only needs to be entered if it is applicable to that denial code.
When the Fiscal Agent submits Medicaid claims, we run audit checks on the claims. You may see the following errors listed. If you have any questions about these errors or how to proceed, please contact the Customer Service Center at 1-866-315-3747 Monday-Friday 7am-7pm.
1. CIN Conflict - This means that there is a discrepancy between the information for a child listed in NYEIS/KIDS and the information listed for that child in eMedNY. To correct a data mismatch, or discrepancy between date of birth or gender, you will need to work with the municipality or local DSS to have the information corrected in the system where it is incorrect. This error may also account for a name conflict, which can be confirmed in the provider's
Medicaid Data Conflicts report.
2. eMedNY ETIN Certification Statement - The provider needs to submit the
eMedNY ETIN Certification form to CSC.
3. eMedNY ERA Request Form - The provider needs to submit the
eMedNY ERA Request form to CSC.
4. Missing Tax ID - A tax ID needs to be entered into the Provider's EIBilling.com profile. Contact Provider Support to have them update this information.
5. Missing Child Address Information - Some information is missing from the child's street address, city, state, or zip code. This needs to be corrected in NYEIS or KIDS - you may need to contact the municipality. If the correction is made in KIDS, the municipality then needs to upload an
insurance batch to EIBilling.com for that information to be received.
6. Missing/Invalid Diagnosis Code - An invalid ICD-9 code was used. Please check the ICD-9 code with the ICD-9 Code reference list under "Reports" in the EIBilling.com menu. If an ICD-9 code that is listed as "Do Not Use" in this report turns out to be appropriate for a claim, contact Provider Support for further assistance. If you need to update the ICD-9 Code you can do so by clicking "Edit/Fix Claim" and updating the ICD-9 Code on the Fix Medicaid Claim Page.
7, 8, 9. NPI for Rendering Provider - This should no longer be an issue. Please contact Provider Support if you see this error.
10. Invalid Billing Provider - The provider is not set up properly as an EI provider. Please contact Provider Support.
11. Missing/Invalid Billing Provider NPI - The provider should contact Provider Support to have them correct the NPI in their EIBilling.com provider profile.
12. Missing/Invalid Tax ID - The provider should contact Provider Support to have them correct the tax ID in their EIBilling.com provider profile.
13. Missing CIN - This means that a child is eligible for Medicaid but we did not receive a CIN from NYEIS/KIDS for them.
Category 2 - 277 RejectionsThe second tab, "Category 2 - 277 Rejections," will list claims rejected by Medicaid at the 277 level that can be corrected. If a claim is rejected at the 277 level, it means that Medicaid rejected the claim for processing.
Providers should read the article for
Medicaid 277 Errors for more information on Medicaid 277 denial codes and how to proceed.
Click "Edit/Fix Claim" to make
corrections to a claim, then "Fix it" on the Fix Medicaid Claim Page and
press "Save Changes and Resubmit Claim". Please note that a delay reason only needs to be entered if it is applicable to that denial code.
Category 3 - 835 ErrorsThe third tab, "Category 3 - 835 Errors," will list claims that were denied at the 835 level. This means that Medicaid processed the claim, but has denied to make payment due to some information that can be corrected.
The "Adjustment Reason Code" and "Remark Code" will show the eMedNY code for that rejection. There is a link at the top of the screen to eMedNY's Adjustment Reason Code Edit Mapping to help providers see why their claims were denied.
Providers should read the article for Medicaid 835 Errors for more information on Medicaid 835 denial codes and how to proceed.
Click "Edit/Fix Claim" to make corrections to a claim, then "Fix it" on the Fix Medicaid Claim Page and press "Save Changes and Resubmit Claim".
Please note that a delay reason only needs to be entered if it is applicable to that denial code. For claims denied with code CO-29, the IFA will resubmit these claims with a delay reason.
If you are unsure of what an error means or how to proceed to correct an 835 error, you should contact eMedNY by phone at
1-800-343-9000.