EI Providers - Cut-over Dates to State Fiscal Agent
Emailed from Andrea Juris, Department of Health
February 13, 2013
Dear Colleague:
As you know, under reforms enacted to the Early Intervention Program (EIP) in SFY 2012-13, the Department and
its fiscal agent(s) will assume responsibility for management of Early Intervention Program claiming on April 1,
2013. The purpose of this email is to provide you with information regarding the Department’s plan for
implementing the transition from municipal to State responsibility for management of provider billing and claiming
of third party payors, and payment to providers, including cut-over dates from provider billing of municipalities to
the Department and/or its fiscal agent(s). The Department’s intent is to ensure this transition is implemented in a
manner which assures continued capacity to deliver timely early intervention services to eligible children and their
families and provide a seamless transition for providers and municipalities.
To accomplish these goals, the Department has determined that municipalities must continue to receive and process
bills from EIP providers with whom they are in contract through March 31, 2013. Providers are required to
continue to adhere to local standards for submission of bills, including documentation necessary to support payment
and claiming, during this time.
For children whose records reside in the KIDS legacy system, providers will use local procedures for submission of
these bills for services rendered to municipalities via paper invoices and where in use, secure file transmission.
Invoices and files submitted by providers and received by the municipality on or prior to March 31, 2013, will be
the responsibility of the municipality. Municipalities must process provider bills, received by either of these
mechanisms by March 31, 2013, including payment of providers, and claims submission to third party payors.
For children whose records reside in NYEIS, providers will use on-line and 837 file transmission to submit bills for
services rendered to municipalities. Provider bills will be the responsibility of the municipality if successfully
submitted in NYEIS (i.e., bills pass edit checks and enter the municipal review cue, or are pended due to a violation
of a billing rule requiring provider justification) by March 31, 2013. Municipalities are responsible for reviewing
and either approving or denying provider bills in municipal review cues as of this date. Approved bills will be
routed for payment by third party payors as applicable, or approved and released for payment by municipalities. In
accordance with current NYEIS business processes, any bills in municipal work cues that are not acted upon within
90 days will be processed and submitted to third party payors and released for payment by municipalities. Denied
bills are not processed any further by NYEIS and providers are required to re-submit these bills in NYEIS.
The Department and/or its fiscal agent(s) will assume responsibility for management of all provider bills on April 1,
2013. EIP providers will be required to use uniform and consistent procedures being established by the Department
for submission of bills associated with children whose records reside in KIDS. The Department is pursuing
contingency plans for securing an interim fiscal agent to manage billing and claiming reliant on KIDS should the
procurement for a Statewide Fiscal Agent not be completed by April 1, 2013. The Department will issue detailed
instructions to both municipalities and providers on billing and claiming procedures using KIDS by mid-March.
EIP providers will continue to use NYEIS for submission of EIP bills for children whose records reside in
NYEIS. The Department and/or its fiscal agent(s) will assist providers in claims submission and adjudication to
third party payors, and will manage payments owed to providers for services not reimbursed by third party payors
centrally at the State level.
Providers will shortly be receiving additional instructions from the Department regarding provider agreements and
enrollment in the Medicaid Program for billing purposes.
We appreciate your efforts on behalf of infants and toddlers with disabilities and their families. We look forward to
a successful collaboration as we work together to implement Early Intervention Program reforms.
Please share this information with your constituents and colleagues.