Attention providers: United Healthcare will no longer accept paper claim reconsiderations or post-service appeal submissions starting February 1 2023. These will need to be submitted electronically. Your electronic submission options 1. UnitedHealthcare Provider Portal: Submit under Claims & Payments. Need help? See the Online Reconsiderations and Appeals interactive guide for a step-by-step guide on how to submit reconsiderations and appeals electronically. 2. Application Programming Interface (API): Consider submitting reconsiderations and appeals through API. Data can be distributed to your practice management system or any application you prefer. API requires technical programming between your organization and UnitedHealthcare, so advanced planning is required. See the full article, please follow the link.

PCG has found that there has been increase of rejections from Medicaid for A7:521-Invalid Claim Adjustment Reason Code (CARC). It has been determined that this is occurring due to incorrectly entered commercial EOBs that are either missing a group code or have an incorrect CARC posted. Medicaid will not be able to correctly process claims if there is not a complete and valid denial posted. Please follow the link for additional details and guidance.

Any agency who are entering Extraordinary Circumstances (ECs) are invited to review the training video posted on the Training page, under ‘Webinars’. These ECs are not entered on a per claim, per child, or per authorization basis, but rather just entered once for the entire overlapping date range the agency is affected, and should be entered within 30 days of relief date. Please follow the link for additional information.

A recent update of EIBilling included an enhancement of the Provider Payment Profile Report, specifically the inclusion of a new row titled 'Closed' claims., Follow this link for additional information on this report update.

When utilizing the Medicaid 835 Remittance Detail Report, please note that there are 2 new date fields, From and To Date (for dates of service). Please select From Date of 4/1/2013 and To Date of current date in order to view all claims within the chosen cycle. Please follow the link to see an image of the date fields.

In accordance with Federal Law, Providers who received payments for Early Intervention Services in the 2022 calendar year should expect to receive a number of 1099 forms. Providers will receive a 1099 from New York State Department of Health via the State Fiscal Agent (SFA) for amounts from the State Escrow account in 2022, a 1099 from Medicaid, and a 1099 from each insurance company. Please follow the link for details.

Please click here to download the 2023 Escrow Payment Calendar

The updated list of the ICD-10 codes that were made available in NYEIS as of January 18, 2023, is accessible via the above link. If providers determine that there is an ICD-10 code needed in NYEIS for billing purposes, a feature request form must be submitted and include both the code and description. The form is available on the Health Commerce System (HCS) in the “Feature Request – Data Change Request” folder within the NYEIS Documents group. Requests will be reviewed prior to being entered into NYEIS. Please allow up to 6 - 8 weeks from the date the Feature Request Form is received for the code to be available in NYEIS. If you need further information regarding NYEIS in general, please contact the NYEIS help desk at nyeis@cma.com or by calling (toll free) 1-(833)-395-7058, or 518-640-8390

The Bureau of Early Intervention (BEI) is implementing an ATB 1% rate increase on payments for Early Intervention (EI) services, including Service Coordination, Evaluations and General Services. The 1% rate increase will be reflected in both Medicaid and Escrow payments. The rate increase will be retroactive and apply to services rendered on or after 4/1/2022. For more information, please follow the link.

On September 1, 2022, the Bureau of Early Intervention sent an email communication to EI Program stakeholders providing an update on the EI-Hub Sandbox user experience. The Bureau and PCG acknowledge the challenges experienced during the roll out of the Sandbox, but believe the Sandbox will provide system users with hands on experience that will help to prepare for the launch of the EI-Hub. BEI will provide approximately two months notice before the EI-Hub launch date. To read the full communication, please follow the link.