New York State Department of Health
New York Early Intervention System (NYEIS) Electronic Mailing List
EI-Hub
Update: Adjustments to Billing Rejection Edits Effective 3/4/2025
Dear Colleague:
To enhance clarity and efficiency in billing
rejections, adjustments have been made to ensure providers receive only the
most relevant rejection reasons. These updates will help providers identify the
true cause of a rejection and focus on actionable steps for resolution. The
information below outlines the specific changes that took effect on Tuesday,
March 4, 2025.
F7 /
F51 Rejections
- Definitions:
- F7 rejection: Date of service and
service type already exists.
- F51 rejection: Claim Start and End
Time. It cannot overlap with another claim.
- Background: Providers often receive
both F7 and F51 rejections. Since the claim is a duplicate, it overlaps
with the prior submission, triggering both rejection reasons.
Adjustment: When an F7 rejection occurs, no additional rejection
reasons will be issued. This ensures that billing providers won’t spend
unnecessary time addressing duplicate claims.
F22
/ F24 Rejections
- Definitions:
- F22 rejection: On the service date
recorded in the claim, the rendering provider was not an active
employee/contractor of the billing provider.
- F24 rejection: The rendering provider
on the claim is not recorded in EI-Hub service auth, or the rendering
provider is not recorded in EI-HUB as a service coordinator for SC claim.
- Background: Providers often receive
both F22 and F24 rejections, as both are related to the therapist's
record. However, they correspond to different sections of the record and
require a different action to resolve:
- Resolving an F22
rejection: Confirm the therapist employment role panel is completed
in the rendering provider’s (includes service coordinators and rendering
providers) therapist record.
- Resolving an F24
rejection: Confirm that the rendering provider on the claim matches
the service authorization rendering provider. For service coordination
claims, the rendering provider's profession must include service
coordination, with a valid start date.
- Adjustment: After 3/4/2025,
providers will only receive an F22 rejection with an F24 rejection if an
update is needed to the therapist’s employment role panel. This change
eliminates unnecessary F22 rejections in most cases and more accurately
identifies the actions billing providers need to take for resolution.
These updates will improve overall claim
processing, enabling billing providers to better understand and address billing
rejections.
Article ID: 546, Created On: 3/5/2025, Modified: 3/5/2025