Attention: Providers Claiming to MetroPlus Health
Plan
Early Intervention (EI) Program services are carved
out of Medicaid Managed Care plans and are billed through Medicaid
Fee-For-Service for children enrolled in Medicaid and whose health care
services are delivered under Medicaid Managed Care. Recently MetroPlus Health
Plan was billed and paid, in error, several claims for Medicaid-enrolled children
in Medicaid Managed Care plans.
As an EI provider that received payment from
MetroPlus Health Plan under these circumstances, you will soon receive a letter
from the plan providing information on the payment error. To resolve the error,
MetroPlus Health Plan will ask that you submit within 30 days, a refund check
to reimburse the plan for the payment in question. The letter from MetroPlus
Health Plan will provide further details on this process.
Immediately following the repayment to MetroPlus
Health Plan, PCG will send the claims to the appropriate payer so that each
Provider is paid promptly for these services. To ensure that you are paid
quickly, please confirm that the Medicaid information that appears in EI
Billing for each child is accurate. To properly bill Medicaid, the child’s
Medicaid client ID number, which is separate and distinct from the child’s
Medicaid managed care plan policy number, must be entered in NYEIS or KIDS.
If you have any questions, please reach out to the
PCG Customer Services Center at (866) 315-3747, or to MetroPlus Health Plan directly
via the contact information provided in their letter.
Article ID: 251, Created On: 4/28/2015, Modified: 10/28/2015