May 08, 2015
The Bureau of Early Intervention (BEI), with the assistance of PCG, will be taking steps to pay EI Billing Providers for claims submitted to Medicaid for the period April 1, 2013 to March 31, 2015 and denied for coordination of benefits (CO-22) for children no longer active in the Early Intervention Program (EIP). The basis for this denial is the child was covered by commercial insurance that was unknown to the EIP and not billed as required prior to submission of claims to Medicaid.
BEI recognizes that EI Providers cannot address missing commercial insurance information in situations where a child’s case is closed. For a child to be deemed inactive in the EIP for the purposes of these payments, the child must either:
- Have turned three (3) years of age on or before January 1, 2015 and are no longer age-eligible for EIP; or
- Be closed from the program and have an inactive IFSP
Claims with a Medicaid CO-22 denial that meet either of these criteria will be paid out of escrow. Please note: Some of the claims for aged-out children may have had known insurance, but since the parents were not able to be reached the insurance could not be verified or added, thus the claims have become unworkable for providers and are being paid.
PCG will send each municipality an estimate of the number, and total amount, of claims that meet the criterion during the week of May 4, 2015. Municipalities can also view claims with Medicaid CO-22 denials in EI Billing in “Medicaid Claims Needing Attention.”
Also note that prior to invoicing municipalities for these claims, PCG will resubmit ALL claims with a Medicaid CO-22 denial to Medicaid for adjudication. This will ensure claims with a CO-22 denial for children whose insurance information was subsequently added or corrected and adjudicated by the commercial payer to be paid by Medicaid.
Payment of these claims through the escrow account will ensure the claims can be included in the Medicaid retroactive claiming process.
PCG will send an invoice to each municipality during the week of May 4, 2015. This process will be identical to how special payments have been handled previously.
If you have any questions, please contact the PCG Customer Services Center at (866) 315-3747.