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New York Department of HealthBureau of Early InterventionState Fiscal AgentTimely Claim Submission Requirementswww.publicconsultinggroup.com

ObjectivesReview timely claim submission requirements,including: The State Regulation Billing Timeframes Define Extraordinary Circumstances Review the billing process related totimely submission and extraordinary circumstances Review added features in EIBilling reports Discuss recommended practices Review Tips and FAQsNY EI SFA Timely Claim Submission Requirements

Amended Regulation, Section 69-4.22(a)(4)Effective February 10, 2019“(4) Providers shall submit all claims for payment of evaluations andservices within 90 days of the date of service, unless submission isdelayed due to extraordinary circumstances documented by the providerand the department’s fiscal agent has been notified of the extraordinarycircumstance and has provided written acknowledgement(i) All claims submitted after 90 days shall be submitted within 30 daysfrom the time the provider was relieved from the extraordinarycircumstance that previously delayed a timely submission.(ii) Claims that are not submitted within timeframes set forth shall notbe reimbursed by the department’s fiscal agent from the escrow funded bymunicipal government payers.”NY EI SFA Timely Claim Submission Requirements

What does this mean?In order to receive reimbursement from Escrow: Claims must be submitted within 90 days of the date of service (DOS) If submitted greater than 90 days after DOS, anExtraordinary Circumstance (EC) must be entered for the claim(s) If an Extraordinary Circumstance is entered for theclaim(s), the claim must be submitted within 30 daysof the Circumstance being relievedNY EI SFA Timely Claim Submission Requirements

What Constitutes anExtraordinary Circumstance? Litigation Natural Disaster Death of Essential Personnel Hospitalization of Essential Personnel Audit Findings State Administrative DelayNY EI SFA Timely Claim Submission Requirements

Process Flow for Claims Greater than 90 daysExtraordinaryCircumstanceoccursProvider worksto resolvetheExtraordinaryCircumstanceNY EI SFA Timely Claim Submission RequirementsExtraordinaryCircumstanceis relievedUser enters theExtraordinaryCircumstancein EIBillingUser entersclaim datainto NYEIS

Adding Extraordinary CircumstancesNY EI SFA Timely Claim Submission Requirements

Extraordinary Circumstances CriteriaSelect ANDConfirmtheCircumstanceSelect ANDConfirmthe Date ofEventSelect ANDConfirmthe Date ofReliefNY EI SFA Timely Claim Submission Requirements

Generate FormOpen,Rename, andSave PDFNY EI SFA Timely Claim Submission Requirements

Submit the Extraordinary CircumstanceNY EI SFA Timely Claim Submission Requirements

Acknowledgement of EntryOpen,Rename, andSave PDFNY EI SFA Timely Claim Submission Requirements

Acknowledgement of EntryOpen,Rename, andSave PDFNY EI SFA Timely Claim Submission Requirements

Maintaining Records ofExtraordinary Circumstances Entry of an Extraordinary Circumstance does notrelieve Billing Providers of maintainingdocumentation to support the claim Billing Providers are responsible for maintainingsupporting documentation for the ExtraordinaryCircumstance Any Extraordinary Circumstance entered intoEIBilling is automatically accepted Claims are subject to auditNY EI SFA Timely Claim Submission Requirements

Extraordinary Circumstance ReportNY EI SFA Timely Claim Submission Requirements

Extraordinary Circumstance ReportThe reportopens to allevents. Thereport may befurther filteredby dates andtype ofextraordinarycircumstanceNY EI SFA Timely Claim Submission Requirements

Timely SubmissionPASTPRESENTDates of service prior to 02/10/2019Dates of service on and after 2/10/2019 Claim is denied by Payer for Timely Filing Error Claim moves to next payer, if applicable Unpaid claim balance is reimbursed withMunicipality funds through the Escrow AccountWITHOUT EC ENTRY Claim is entered in NYEIS 90 days after DOSExtraordinary Circumstance is not applicableClaim is billed to payer(s), as usualClaim balance is adjusted to 0-OR-WITH EC ENTRY NY EI SFA Timely Claim Submission RequirementsClaim is entered in NYEIS 90 days after DOSExtraordinary Circumstance is enteredClaim is billed to payer(s), as usualClaim is ultimately moved to Escrow, ifapplicable16

Claims Submitted After 90 DaysFrom the Date of ServiceWithout Extraordinary Circumstance Entered in EIBillingSubmitted to: Commercial Insurance Medicaid BUT NOT ESCROWNY EI SFA Timely Claim Submission RequirementsESCROW

Claims Submitted After 90 DaysFrom the Date of ServiceWith Extraordinary Circumstances Entered in EIBillingSubmitted to: Commercial Insurance Medicaid EscrowNY EI SFA Timely Claim Submission RequirementsESCROW

Claims Submitted With Extraordinary CircumstanceAfter 30 Days of EC ReliefSubmitted to: Commercial Insurance Medicaid BUT NOT ESCROWNY EI SFA Timely Claim Submission RequirementsESCROW

Claims Submitted With Extraordinary CircumstanceWithin 30 days of EC reliefSubmitted to: Commercial Insurance Medicaid EscrowNY EI SFA Timely Claim Submission RequirementsESCROW

Processing Claims in EIBilling After Regulation ImplementationClaims arereceived fromNYEIS intoEIBillingIs the DOSon or after02/10/2019?YesIs the DOS 90 daysof datesubmittedin NYEIS?YesHas an ECbeenenteredand matchthe claim?NoNoClaim followsnormal processNoIs today’sdatewithin 30days of ECrelief?NoYesAgency orProvider mayenter an ECYesEIBilling alerts user thatclaims is 90 days & will notbe paid from EscrowClaim will be marked as 90days & processed toInsurance and/or MedicaidClaim will be adjusted foramount not paid for beinglate & Escrow will show 0NY EI SFA Timely Claim Submission Requirements

New Timely Submission Section on DashboardNY EI SFA Timely Claim Submission Requirements

Claim Status ReportNY EI SFA Timely Claim Submission Requirements

New Columns in ReportsThe new column will reflect the amount not paid by Escrow.It can be found in several reports, including: The Claims Research Report The Detail Claims Report The Detail Transaction ReportNY EI SFA Timely Claim Submission Requirements

Claims Research ReportLate Claim AdjustmentcolumnNY EI SFA Timely Claim Submission Requirements

Detail Claims ReportLate Claim AdjustmentcolumnNY EI SFA Timely Claim Submission Requirements

Detail Transaction ReportLate Claim AdjustmentcolumnNY EI SFA Timely Claim Submission Requirements

Recommended Billing TimeframeNY EI SFA Timely Claim Submission Requirements

Recommended PracticesBEST PRACTICESubmit claims inNYEIS and ensurethey receive astatus of SystemApproved no laterthan the first Fridayafter the date(s) ofserviceNY EI SFA Timely Claim Submission RequirementsMODERATEPRACTICENOT A BESTPRACTICESubmit claims inNYEIS and ensurethey receive astatus of SystemApproved no laterthan the firstSaturday at 12pmafter the date(s) ofserviceSubmit claims inNYEIS on aMONTHLY BASISand receive astatus of SystemApproved laterthan the firstSaturday at 12pmafter the date(s) ofservice

TIPS Submit claims regularly to increase the frequency of payment, reducetime needed to address errors, and helps avoid the possibility of losingescrow payments on late claims Submit claims within 30 days of the Extraordinary Circumstance dateof relief or it will be considered late and will not paid from escrow Be sure to maintain records supporting the extraordinary circumstanceentered. If an audit is conducted and documentation is not available ordoes not support the extraordinary circumstance escrow payment will berecoupedNY EI SFA Timely Claim Submission Requirements

RECAP The amended regulation is as of February 10th 2019. The date of service is when the 90-day claim submission countdownstarts to get the claim in NYEIS (system approved) without anextraordinary circumstance. Claims submitted past 90 days of the date of service without anExtraordinary Circumstance WILL be sent to the child’s insurance and/orMedicaid plan on file but WILL NOT be sent to escrow. Claims with an Extraordinary Circumstance with be submitted in NYEISwithin 30 days of the date of relief.NY EI SFA Timely Claim Submission Requirements

FAQ1. Do I HAVE to enter an Extraordinary Circumstance if myclaim is greater than 90 days?2. What happens if audit results show I do not have or havelost the supporting documentation for an ExtraordinaryCircumstance?3. What if my Extraordinary Circumstance does not fall intoone of the listed categories?NY EI SFA Timely Claim Submission Requirements

Any Questions?NY EI SFA Timely Claim Submission Requirements

NY EI SFA Timely Claim Submission Requirements

Training InformationFor more topics, see the Knowledge Base: https://support.eibilling.comSchemicah AlexanderInstructional TrainerMatthew O’BrienInstructional TrainerFor additional free personalized training, please contact the Training Team at:NY Early Intervention Training Emailnyeitraining@pcgus.comCustomer Service CenterMonday-Friday, 7a-7p1-866-315-3747NY EI SFA Timely Claim Submission Requirements35

Public Consulting Group, Inc.148 State Street, Tenth Floor, Boston, Massachusetts 02109(617) 426-2026, www.publicconsultinggroup.com

starts to get the claim in NYEIS (system approved) without an extraordinary circumstance. Claims submitted past 90 days of the date of service without an Extraordinary Circumstance WILL be sent to the child's insurance and/or Medicaid plan on file but WILL NOT be sent to escrow.