546- EI-Hub Update: Adjustments to Billing Rejection Edits Effective 3/4/2025

 New York Early Intervention System (NYEIS) Electronic Mailing List

EI-Hub Update: Adjustments to Billing Rejection Edits Effective 3/4/2025

Dear Colleague: 

To enhance clarity and efficiency in billing rejections, adjustments have been made to ensure providers receive only the most relevant rejection reasons. These updates will help providers identify the true cause of a rejection and focus on actionable steps for resolution. The information below outlines the specific changes that took effect on Tuesday, March 4, 2025.

F7 / F51 Rejections

• Definitions:
  • F7 rejection: Date of service and service type already exists.
  • F51 rejection: Claim Start and End Time. It cannot overlap with another claim.
• Background: Providers often receive both F7 and F51 rejections. Since the claim is a duplicate, it overlaps with the prior submission, triggering both rejection reasons.
  Adjustment: When an F7 rejection occurs, no additional rejection reasons will be issued. This ensures that billing providers won’t spend unnecessary time addressing duplicate claims.
   

F22 / F24 Rejections

• Definitions:
  • F22 rejection: On the service date recorded in the claim, the rendering provider was not an active employee/contractor of the billing provider.
  • F24 rejection: The rendering provider on the claim is not recorded in EI-Hub service auth, or the rendering provider is not recorded in EI-HUB as a service coordinator for SC claim.
• Background: Providers often receive both F22 and F24 rejections, as both are related to the therapist's record. However, they correspond to different sections of the record and require a different action to resolve:
  • Resolving an F22 rejection: Confirm the therapist employment role panel is completed in the rendering provider’s (includes service coordinators and rendering providers) therapist record.
  • Resolving an F24 rejection: Confirm that the rendering provider on the claim matches the service authorization rendering provider. For service coordination claims, the rendering provider's profession must include service coordination, with a valid start date.
• Adjustment: After 3/4/2025, providers will only receive an F22 rejection with an F24 rejection if an update is needed to the therapist’s employment role panel. This change eliminates unnecessary F22 rejections in most cases and more accurately identifies the actions billing providers need to take for resolution.

These updates will improve overall claim processing, enabling billing providers to better understand and address billing rejections.