Guidance on Non-Regulated Insurance Plans
Billed in Error
Service Coordination Responsibilities
Dear
Colleague:
Service coordinators are responsible to obtain insurance information from
families and to update this information as needed to ensure it is accurately
documented in the Department’s data systems (NYEIS and KIDS). It is this
documentation in the data system which drives third party insurance billing.
The data in NYEIS is sent to the State’s fiscal agent in order to process
claims.
Service
coordinators should proceed to verify insurance information for all children on
their caseloads, immediately and regularly thereafter.
For
children whose records are maintained in the KIDS system: Service
coordinators must provide the insurance information to the municipality to
record. Municipalities must correct the insurance information maintained
in the KIDS system.
For
children whose records are maintained in the NYEIS system: Service
coordinators must enter accurate information in NYEIS regarding the regulated
status of the family’s insurance plan.
To accurately identify whether an insurance plan is
regulated by New York State Insurance Law, service coordinators should
contact the insurance company directly. Please note, the determination is
made at the plan level (e.g., a single insurance company may have some
plans that are regulated and others, such as self-funded plans, that are
typically not regulated).*
On the child's commercial insurance page in
NYEIS, there is a drop down box to indicate whether the plan is, or is
not, regulated by New York State. Service coordinators must select
the appropriate option in order for family’s insurance benefits to be
protected.**
There also is a required field on the child's commercial
insurance page in NYEIS for parental consent to bill insurance that
is not regulated by New York State. Service coordinators must choose
either “Yes” or “No” in this field.**
Please note, if the parent declines to provide
insurance information, this declination must also be documented. On the child's
home page in NYEIS, there is a cluster labeled Insurance
Information and a field to indicate if the parent declined to give
insurance information.**
*Face-to-face
and telephone contacts with insurers for the purpose of determining the
regulated/non-regulated status of a family’s commercial insurance plan are
billable service coordination activities. Contacts made by e-mail or letter are
not billable.
**Detailed
procedures for entering insurance can be found in the NYEIS User Manual, Unit
10, Municipal Administration (the User Manual describes this as a municipal
function, however, with the promotion of NYEIS Version 2.0 and 3.0, service
coordinators now have the ability to enter insurance information). In addition,
a webinar will be presented in the near future to walk through the process of
adding/editing insurance information in NYEIS.
Should you
have additional questions, please email bei@health.state.ny.us.
If you have
any questions or need further information regarding NYEIS, please contact the
NYEIS helpdesk at nyeis@cma.com or 518-640-8390.
Please
do not reply to this e-mail announcement.
Thank You.
Article ID: 133, Created On: 11/14/2013, Modified: 10/27/2015