502- 837 FAQs

FAQ
Jun 06, 2024

  • Will the EI-Hub allow the use of third-party systems to upload 837 files?
    • Yes, if you currently use a third-party system that produces a file to submit claims into NYEIS, you can submit them in the EI-Hub using a similar process. The EI-Hub companion guides for electronic claiming for 837P, 277CA, and 999 file transactions are available in the EI-Hub LMS.
  • Which user role(s) can upload 837 files into the EI-Hub? Where do users upload 837 files in the EI-Hub?
    • 837 files are uploaded into the Case Management component in the EI-Hub. The following user roles will have the capability to upload 837 files:
      • Universal Provider role (Superuser) (UniversalProvNY)
      • Provider fiscal manager role (ProvFiscalMgrNY)
      • Provider data entry role (ProvDataEntryNY)
      • Individual provider role (InProviderNY)
    • PCG will also be available to support users with this function as needed.
  • How do Billing Providers using a third-party billing system make billing corrections in the EI-Hub (i.e., void a claim)? 
    • During the billing and claiming process, billing providers utilizing a third-party system will upload their 837 files into the Case Management component of the EI-Hub. The claims will be validated, and the status of the claims (approved/denied) will appear on a 277 file. Billing providers will not have to void any denied claims; they can adjust them in their third-party system and resubmit those corrected claims in Case Management. If an approved claim needed to be voided, this could be completed by sending a void claim in a subsequent 837 file.
    • For additional information, please reference the companion guides on the Learning Management System (LMS).
  • How can Billing Providers using a third-party billing system register to participate in Provider Claims Loader testing?
    • Provider claims loader testing allows billing providers to test the submission of claims from their third-party systems/clearinghouses through the 837 file upload process. Testing of this functionality will be conducted in a phased approach, with agencies and providers who currently utilize third-party systems having an opportunity to test the process before the launch of the EI-Hub. Those interested in participating in provider claims loader testing can email NYSFAEIP@pcgus.com. 
  • Will system users be able to create claims using both the EI-Hub’s Service Logging (SL) component and the 837 upload process?
    • The EI-Hub is configured to allow system users to complete SL using either the EI-Hub’s SL or through the 837 file upload process. System users will be assigned a service logging method in the Hub based on their current method. Following the launch of the EI-Hub, system users can elect to switch their service logging method. It is important to note that system users cannot alternate between service logging methods in the EI-Hub, meaning an individual cannot use the EI-Hub's Service Logging component and a third party for billing and claiming general services. However, counties utilizing a third-party system can submit claims for general services, including service coordination, through an 837 and use the EI-Hub Service Logging component only for transportation and respite claims. 
  • Once the EI-Hub is launched, how will system users know if their claims were accepted or rejected? 
    • System users using the EI-Hub’s Service Logging componentwill log their service and then upload their claims to a voucher in the Case Management component. When claims flow from Service Logging to Case Management, they undergo a validation process. Under the ‘Attendance’ menu, approved claims will appear in the ‘Bill to State’ option. These claims are uploaded to a voucher and sent to EI Billing for payment. Once sent to EI Billing, approved claims will also appear in the ’Posted Attendance Report’ report. Under the ‘Attendance’ menu, denied claims will appear in the ‘Billing Rejections’ option.
      • System users uploading claims to the Case Management component through the 837 file upload option will receive 999 files and 277 files outlining the status of their claims. The 999 file will indicate if the 837 file was accepted or rejected. The 277 files will indicate which claims within the 837 file were accepted or rejected. Accepted claims will move on to EI Billing for processing to payors. Under the ‘Billing’ menu, billing providers can view accepted claims in the ‘AR Details’ report.
    • In EI-Billing, all users can see claims under the ‘claims in process’ report.
  • Once the EI-Hub is launched, what is the process for correcting/voiding claims?
    • System users utilizing the EI-Hub’s Service Logging component will receive a notification in Service Logging if a claim does not pass the initial validation process. These claims can be flagged and corrected before being sent to the next billing and claiming process step. In most cases, claims can be corrected without voiding. If a claim passes through the validation process in Service Logging but is denied in Case Management, system users can see the denied claims under the ‘Attendance’ menu in the ‘Unbilled Attendances’ option. From here, claims will be voided, and rendering/billing providers will fix the claim in Service Logging. 
      • System users uploading claims to the Case Management component through the 837 file upload option will receive a 277 file. The 277 file is designed to upload to a third-party application. It will provide information within the third-party system on which claims have been accepted and which have been rejected with the rejected reason(s), thus allowing users to fix claims and resubmit. Under the ‘Billing’ menu, billing providers can view accepted claims in the ‘AR Details’ report.
    • In addition, companion guides are available on the LMS for 837/999/277 files. Companion guides are intended for EI providers exchanging electronic data with the EI-Hub solution. The guides provide detailed technical instructions on required data content for claims submissions. Any claim needing to be voided and/or corrected because it was accepted into EI-Billing and later determined to be billed incorrectly will need to follow the 837 voids and corrected claims process outlined in the 837 Companion Guide.
  • Can data entry staff enter claims and/or verify claims were submitted for payment for their agency?
    • The agency’s role as administrator is to determine access to the Case Management component. If an agency grants their clerical staff access to the Case Management component, they can upload 837 files and view the status of their claims in the ‘AR Details’ report. 
  • How many claims can be included in an 837 file (x12)?
    • The 115-character limit described in the disclaimer when uploading an 837 file only applies to the file name. Following the launch of the EI-Hub, approximately 5,000 claims can be included in a single 837 file upload. 
  • Will system users be able to see the dollar amount for accepted and rejected claims?
    • System users utilizing the EI-Hub’s Service Logging component can view the dollar amounts for claims in the ’Posted Attendance Report’ report.
    • System users uploading claims to the Case Management component through the 837 file upload option can view the dollar amounts for claims on the 277 file and/or in the ‘AR Details’ report. 
  • My agency uses a third-party data management company. How can I transfer my provider/agency information into the EI-Hub?
    • The EI-Hub will have several reports that allow users to download provider information from the EI-Hub into an Excel (xls) or comma-separated (CSV) file that could be loaded into a third-party system. The system cannot download/import similar files into the EI-Hub system except by uploading an electronic 837 claim file. 
  • Will there be an opportunity to submit test 837 files before the launch of the EI-Hub?
    • Yes, end users who utilize third-party systems and submit to NYEIS through 837 file uploads will have an opportunity to test the submission of these files before the EI-Hub launch. 
  • During provider claims loader testing, will providers use test files or files generated from their third-party system to test the functionality of uploading 837 files into the Case Management component of EI-Hub?
    • During provider claims loader testing, providers will use test child data from a report exported from the EI-Hub’s Case Management component. The report (Title: Child Info and Authorization) will contain a list of children assigned to an agency/county with active service authorizations. Testers will upload the child data from this report into their third-party system to generate an 837 file. This 837 file is then uploaded into the Case Management component through the 837 file loader and follows the standard billing and claiming process for system users utilizing a third-party system. 
 
Article ID: 61, , Modified: 7/13/2026 at 1:01 PM
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