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.

MVP is now rejecting claims if the Billing Provider’s address does not contain a 9 digit zip code. When the provider receives the MVP rejection of “EE-PN4-0379_INVALID BILLING PROVIDER ZIP", you must update your billing address with both with BEI and NYEIS to include the 9 digit zip code. Please resubmit the claims after you see the updated address in your provider profile in EI Billing.

View More Links

On November 30, 2018, the Bureau of Early Intervention announced a Social-Emotional Development webpage for families on the Department of Health Bureau of Early Intervention website. Please follow the link for more information and to access the webpage.

Please be aware that three ICD-10 codes were removed effective October 1, 2018. PCG is notifying EI Providers of this change so that you can make any necessary changes to assist you with reimbursement. Please check your Needs Attention screens in EI Billing to avoid any delays in processing claims that have been denied for these codes. Follow the link for the list of deleted codes, including appropriate suggested replacement codes.

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 April 30, 2018 and denied for coordination of benefits (CO-22) for children no longer active in the Early Intervention Program (EIP). For more information on invoicing and actions required by municipalities, please follow the link.

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 April 30, 2018 and denied for coordination of benefits (CO-22) for children no longer active in the Early Intervention Program (EIP). For more information on payment to providers, please follow the link.

On February 13, 2018, eMedNY sent an notice to all Medicaid providers about a change in policy for claims submitted to Medicaid with Delay Reason Code 3, State administrative delay. This change does not impact Early Intervention (EI) claims, which are considered clinic claims by eMedNY. Clinic claims are exempt from this change. No action is required on your part in response to the eMedNY notice. If you have any questions, please contact the PCG Customer Service Call Center at (866) 315-3747.

View More Links