New York Department of Health
Bureau of Early Intervention
State Fiscal Agent
NY EI SFA Steering Committee
September 23, 2013
www.publicconsultinggroup.com
Agenda
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Introductions
Purpose of the Steering Committee
PCG SFA Go-Live
Customer Service Call Center
Enhanced Web Site
New Training
Current Challenges, and Remedial Action Plans
Other Business
Next Meeting
NY EI SFA Steering Committee - September 23, 2013
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PCG
 Public Consulting Group (PCG)
is a management consulting
firm headquartered in Boston,
MA
 PCG specializes in consulting
services to governmental
agencies on federal, state and
county-based levels. The map
to the right illustrates our
national experience
NY EI SFA Steering Committee - September 23, 2013
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PCG’s Experience
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PCG is a national leader in providing SFA services processing over $1.2B
annually for 50 programs on behalf of clients in 22 states
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PCG assists more than 20 states with call center operations, supporting
650,000 health care consumers and 300,000 providers
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PCG leverages the research and practices of the Project Management
Institute’s Project Management Body of Knowledge (PMBOK) as a
guidepost to all of our projects and will do so here
NY EI SFA Steering Committee - September 23, 2013
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PCG SFA Go-Live
project area
current state
October
next phase
Provider Support
Communications
Plan Approved
Implement Communications
Training
Plan Approved
Implement Training
Call Center
Planning and Preparation
Online 10/1/2013
Ongoing
Mail Room
Planning and Preparation
Online 10/1/2013
Ongoing
As-Is Modeled
Correction of Urgent
Problems
Continuous Quality
Improvement
Standard Operations
McGuinness with support from
PCG
PCG
Backlog
McGuinness works the backlog
PCG works the backlog
No backlog
Payers
Medicaid
Clearinghouses (Emdeon, Post-NTrack)
Medicaid
Clearinghouses (e.g.
Emdeon, Post-N-Track)
Direct to Payers (e.g.
Excellus)
Medicaid
Clearinghouses (e.g. Emdeon,
Post-N-Track, additional)
Direct to Payers (e.g. Excellus,
additional)
McGuinness
McGuinness, with enhanced
UI and Reporting, if required
PCG SFA System
Business Process
Redesign
Billing and Claiming
SFA System
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Purpose of the Steering Committee
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Comprises stakeholders including providers, municipalities, parents,
Department of Health and Financial Services representatives, and
insurance industry representatives
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Avenue for stakeholder engagement and involvement
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Two-way channel for information sharing throughout the SFA transition and
operation
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PCG Staffing
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The SFA will deploy 53 staff members to support implementation and ongoing operations
Position or Area of Responsibility
Manager
FTE Count
Manager
Rick Dwyer
1.0
Enterprise Management Office
Joe Baile
1.0
Deputy Project Manager
Jamie Kilpatrick
1.0
Technical Advisor
Maureen Greer
0.8
Business Process Review
Nathan Grossman
3.0
Information Technology Department
Michael Dieter
9.0
Accounting, Billing and Claims
Stephen Greene
18.0
Pam Fuqua
19.0
Operations
Customer Service
Total FTE Count
NY EI SFA Steering Committee - September 23, 2013
52.8
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Customer Service Call Center
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Beginning on October 1, 2013
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Staff have been trained on NY-specific claiming processes
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Help users with:
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EI billing process
forms management
Medicaid documentation
walkthroughs of the claiming process and systems
other items related to the Fiscal Agent
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Available from 7 a.m. to 7 p.m. ET Monday through Friday, toll-free number
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Current inquiry and knowledge base is being transferred to PCG
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Enhanced Website
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Keep the same EI Billing web address and name
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Same login and password
Same functionality
Same knowledge and system information
Enhance the website based on initial user feedback, reorganized to offer
better accessibility to information users need to:
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Find data
Input information
Complete billing
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PCG will send specific communication to website users on changes as they
are rolled out
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The site will continue to be updated as PCG reviews user feedback,
enhances processes, and addresses issues raised during the interim process
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EIBilling: New Home Page Mockup
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EIBilling: New Training Page Mockup
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EIBilling: New Contact Page Mockup
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New Training
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Increase the availability of training for providers and service coordinators
regarding billing and claiming
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PCG training staff will be available to meet with groups to help them better
understand and use the system
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NYS-based Regional trainers
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New calendar of training webinars for municipalities, providers, and service
coordinators
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Participants will be able to access these webinars live or view a recording
from the training section of the EIBilling site
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A link to register for these training webinars with sign-up instructions are
being emailed to stakeholders now
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Training Schedule
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Phase 1 of training has begun: Provider introductions to the SFA webinars
begin September 23, 2013 and continue until October 8, 2013
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Training is being recorded and so available at any time
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Training Goals and Objectives:
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Implement an efficient and effective administrative process for the payment of
early intervention claims through a State Fiscal Agent (SFA)
Ensure all stakeholders understand the purpose for, and implications of, the
introduction of a State Fiscal Agent
Ensure that each individual stakeholder understands how the SFA impacts them
individually as well as the system as a whole
Ensure stakeholders understand and, where required, execute new
responsibilities, processes and procedures.
Ensure stakeholders know what to do, who to call, and how to get help
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Training Topics
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Some of the Provider training topics that will be covered after the initial
introductory webinars are as follows:
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Insurance 101
835 & 277 Denials
Health Savings/Spending Account (HSA) Billed in Error
Guidance for Parent’s Receiving Checks for EI Services
Explanation of Benefits (EOB) and Subrogation
Regulated and Non-Regulated Insurance
Prior Authorizations
PCG looks for user feedback when designing training
NY EI SFA Steering Committee - September 23, 2013
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Further Training
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Service Coordinator trainings will also be initiated in October
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Introduction of the New York Early Intervention State Fiscal Agent
Outline the EI Service Coordinator’s role/responsibilities regarding the
billing/claiming procedures
Increase understanding of the new claiming process
Training will be ongoing for stakeholders, including municipalities, providers,
parents, insurance companies, advocates, others
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Current Challenges
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Challenge Being Addressed
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Payment delays to providers due to delays in commercial third party payment
processing (inc. resolve return of 835 and Remittance information to State Fiscal
Agent)
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Define a best practice for service coordinators and providers, leading to their greater
confidence, data accuracy, and claim correction
3
Define claim rejection and denial reasons to tailor proper follow-up responses and
training and education programs for service coordinators and providers
4
Greater understanding of the impact of current system of payment policies on third
party claiming
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Challenge Action Plan #1
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Challenge: Payment delays to providers due to commercial third party
payment processing policies (includes resolving return of 835 and
Remittance information to State Fiscal Agent)
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Action Plan
• Lead Actions:
• Conduct Provider Contracting and Credentialing with Payers
• Pursue industry assisted processing change for EI claims for nonparticipating Providers
• Support Actions
• Conduct training and support for Providers and Service
• Coordinators
Industry-wide effort processing of EI claims for non-participating
Providerscommunications to Providers, Service Coordinators and
• Conduct
Payers
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Changes to Insurance Companies
Payment Processes
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Prioritize Commercial Insurance companies with high volumes of EI claims
and work with them to find and implement solutions
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Success Story: Excellus Health Plan
• Changed information system to allow remittance advices to be sent to the SFA and
payments to providers
• Adhering to subrogation requirements to ensure payments are directed to providers and
not families
• Sending a letter to all members / EI parents who received misdirected payments owed
to providers
• Providing a report to the SFA on all EI claims processed since April 1 with remittance
advice information
• Letter from DOH and Excellus to providers with instructions
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Success Story: Health Now Plan
• Plan on contracting with billing providers
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Challenge Action Plan #2
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Challenge: Define a best practice for service coordinators and providers,
leading to their greater confidence, data accuracy, and claim correction
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Action Plan
• Lead Action: Review collection issues; conduct root cause analysis
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Support Actions
• Interview Providers & Service Coordinators
• Conduct As-Is analysis of family and provider enrollment and
cases management practices
• Develop troubleshooting guidance & business process change
plans as needed
• Conduct communication, training and support to Providers and
Service Coordinators
NY EI SFA Steering Committee - September 23, 2013
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Challenge Action Plan #3
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Challenge: Define claim rejection and denial reasons to tailor proper followup responses and training and education programs for service coordinators
and providers
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Action Plan
• Lead Action: Analyze Insurance Claiming Results
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Support Actions
• Enhance processes for directing claims to Providers or Service
Coordinators for correction, aided by SFA claiming and customer
service teams
• Conduct training and support to Providers and Service
Coordinators
• Conduct communications to Providers and Service Coordinators
NY EI SFA Steering Committee - September 23, 2013
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Challenge Action Plan #4
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Challenge: Greater understanding of the impact of current system of
payment policies on third party claiming
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Action Plan
• Lead Action: Review program rules and administrative requirements to
enhance business practices
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Support Actions
• Design acceptable enhanced business practices
• Conduct training and support to Providers and Service
Coordinators
• Conduct communications to Providers and Service Coordinators
• Assess potential NYEIS changes
NY EI SFA Steering Committee - September 23, 2013
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Assistive Technology Devices
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Assistive technology devices authorized in children’s IFSPs
Assistive technology devices will continue to be accessed through loan
programs (e.g., TRAID, municipal loan closets), if available and appropriate
for the child
The PCG Assistive Technology Coordinator will collaborate with the
municipalities/counties to facilitate the purchases through ATD vendors
Payment for the purchased devices will primarily originate from commercial
and public insurance, with the municipalities/counties being responsible for
the residual
A pricing methodology will be implemented to ensure cost-effective
procurement of ATDs
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Other Business
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Contact Sheet
Rick Dwyer
Jamie Kilpatrick
PCG Project Manager
rdwyer@pcgus.com
(617) 717-1250
PCG Deputy Project Manager
jkilpatrick@pcgus.com
(615) 983-5318
Joe Baile
Nathan Grossman
PMO Manager
jbaile@pcgus.com
(617) 717-1241
Business Process Redesign Manager
ngrossman@pcgus.com
(617) 717-1189
Stephen Greene
Rob Lillpopp
Billing and Claiming Manager
sgreene@pcgus.com
Communications Lead
rlillpopp@pcgus.com
Tina Chen-Xu
Consultant
tchenxu@pcgus.com
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Public Consulting Group, Inc.
148 State Street, Tenth Floor, Boston, Massachusetts 02109
(617) 426-2026, www.publicconsultinggroup.com
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