For children enrolled in NYEIS, the process is very similar
to how it has been. Follow the right side of the accompanying chart. As a
provider, continue to submit your claims to NYEIS.
The system will run Edit Checks to verify the claims are valid. (Edit checks
consist of a set a questions: are there enough units left, is the information
provided for this claim valid, is this a valid CPT code, etc.) Once the claims
have passed the Edit Checks in NYEIS, NYEIS will forward all of the valid
claims to the Interim Fiscal Agent to process through their Fiscal
Administration System. At this point, the Fiscal Administration System will
manage submitting the claims to Commercial Insurance, submitting claims to
Medicaid, and retrieving any remaining balance from the statewide Escrow
Account.
The left hand side of the chart shows the process for
children enrolled in KIDS. First, service records must be submitted to the
EIBilling.com website. The counties will then run these records through KIDS to
perform the Edit Checks. These Edit Checks are very similar to the Edit Checks
run for the children enrolled in NYEIS. Once the claims have passed the Edit
Checks in KIDS, KIDS will upload the valid claims to the Fiscal Administration
System for the Interim Fiscal Agent to take over and process the claims.
Article ID: 4, Created On: 4/10/2013, Modified: 10/28/2015