May 15, 2014
The recently enacted New York State SFY 2014-15 budget allows providers of Early Intervention services to be reimbursed by municipalities, through the Early Intervention (EI) escrow account for claims submitted to third-party payers including the Medicaid Program during the period 4/1/2013 - 6/30/2013, which remain unadjudicated as of April 1, 2014. Payments were subject to any safety net reductions and current negative balances providers may have for previously overpaid claims.
If a provider believes the payment they received was not correct, the State Fiscal Agent (SFA) asks the provider to take the following steps to review the billing information they have before moving to the next step in the process.
· Reimbursed claims are based on the date the claim was received in EIBilling, not date of service
· Remember that payment is only being made on claims received in the system from 4/1/13 through 6/30/13 that should have been reimbursed by third-party insurers including Medicaid and not for claims that were rejected in the NYEIS or KIDS systems
· Compare the provider’s billing records with those in EIBilling for the time period of 4/1/2013 through 6/30/2013
· Note any negative balance that the EIBilling records show in that time period, as they will be subtracted from the payment amount
· Note any negative balance EIBilling indicates the provider had from 6/30/13 through 5/13/14, as they will also be deducted from the payment amount
· If a provider still has an outstanding Safety Net balance, twenty-five percent of the payment due to the provider will be deducted from the payment amount and applied to the Safety Net balance
Once the provider has reviewed this data and still believes they received an incorrect payment, they should contact the PCG Customer Services Center at 1-866-315-3747 and speak with a representative to review the data. If after that step is taken the provider still believes they have received an incorrect payment, they can fill out an Article VII Payment Dispute Form (Article VII Dispute Form.pdf) and return it along with supporting billing data to the Secure Fax listed below. Disputes will be reviewed in the order they are received and providers may be asked to provide additional billing and claiming information if more information is needed to complete the process.
Secure Fax: 1-518-836-0328