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Effective January 1, 2018, CPT code 97532 (cognitive skills development, each 15 minutes) will be removed and replaced with CPT code 97127 (Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact). Billing providers should advise their therapist and billing staff of these changes.

The SFA has noticed an increase in Aetna rejections due to provider or therapist NPI number not being registered with Aetna. Please follow the link to register your NPI number with Aetna. You may choose to send in five or fewer at a time or request a spreadsheet to submit more than 6 at a time. This will ensure that your claims will be accepted and adjudicated by Aetna.

The SFA has seen a large increase in rejections for claims sent to Beacon Health Options. Providers that have children with Beacon Health Options (formerly Value Options) for which the claims address used to be PO Box 1800 in Latham, NY, the address has now changed, so please select Beacon Health 600475 in NYEIS with the P.O. Box 1850, Hicksville, NY 11802-1850.

Want to check if a referring provider is enrolled as an OPRA provider? Check a rendering therapists' NPI? Look up an 835 Denial Code? Follow the link for these and more useful links.

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The Bureau of Early Intervention has been informed by Medicaid/CSRA that due to the high volume of claims submitted during the week of 7/1/2019, not all claims submitted on 7/3/2019 were processed in the cycle 2185 with payment date of 7/8/2019. These claims will be processed in cycle 2186 with payment date of 7/15/2019. For providers on the accelerated payment schedule (off the 2 week lag), claims expected to be paid on 7/8/2019, will be paid on 7/15/2019. For providers on the 2 week lag, claims expected to be paid on 7/24/2019 will be paid on 7/31/2019.

The 2019-20 Enacted Budget included a 5% rate increase for approved rehabilitation services rendered by licensed speech pathologists, licensed occupational therapists, and licensed physical therapists. Follow the link for a summary and FAQs associated with this increase.

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 February 28, 2019 and denied for coordination of benefits (CO-22) for children no longer active in the Early Intervention Program (EIP). Please follow the link for invoice and payout information for municipalities.

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 February 28, 2019 and denied for coordination of benefits (CO-22) for children no longer active in the Early Intervention Program (EIP). Please follow the link for payment information for providers.

Some EI Billing Providers are receiving commercial insurance denials due to incorrect unit designations for in their coding for certain speech-language therapy services. Please follow the link for information on how to correct this issue.

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