The article outlines the importance of maintaining Medicaid enrollment through recertification and revalidation. The article also outlines the necessary steps to maintain each type of enrollment. Follow the link for more information.

A helpful grid outlining when a corrected claim, void, resubmittal/adjustment are done is now available for reference. Please follow the link for additional details.

PCG has found that there has been an increase in incorrect use of Medicaid delay reason codes. It is the responsibility of the providers to utilize the appropriate delay reason codes. Delay reason codes are used on claims billed beyond Medicaid’s 90-day initial filing limit or when resubmitting claims with updated information within the 60-day resubmission window of claims denied or rejected. Please follow the link for additional details and guidance.

If your Medicaid claims were denied due to the expiration of the filing time limit (code 29), and you used delay reason code 15 (related to a natural disaster or state of emergency), the Department of Health (DOH) can review them manually. To learn more about why code 15 was valid for your claims, please contact the Bureau of Medical Review's Pended Claims Unit at 1-800-342-3005 (select option 3).

PCG has found that there has been an increase in ongoing rejections from Medicaid due to providers utilizing invalid or expired ICD-10 codes. Please follow the link for additional details and guidance.

In preparation for the transition to the EI-Hub, the Bureau of Early Intervention’s (BEI) Provider Approval Unit (PAU) will stop accepting paper re-approval applications several weeks prior to the EI-Hub launch. Once the EI-Hub launches, providers will be able to submit their re-approval requests directly through the EI-Hub provider management module. A communication was sent to stakeholder on 06/24/2024 with revised transition deadlines based on an October 15, 2024 launch date for EI-Hub. For more information, please follow the link.

On 6/24, the Bureau of Early Intervention (BEI) announced additional training opportunities coming this summer. BEI created a comprehensive communications packet that outlines all available training opportunities. The packet includes detailed information on each training item, such as participation instructions, availability dates, and registration links where applicable. Recognizing that everyone learns differently, we have provided a diverse range of options to meet individual needs. Please follow the link for more details.

BEI released communications announcing that the EI-Hub system launch was rescheduled to October 15, 2024. Please follow the link to view the formal communication.

A list of the CPT codes accessible in the EI-Hub that are typically utilized for ABA services. We recommend referring to this list when preparing 837P files to mitigate rejections due to CPT code.  We also recommend sharing this information with your claims vendor to facilitate any necessary modifications to their system.  Please follow the link for more details.

Updated list of the CPT codes accessible in the EI-Hub. Use this list when preparing 837P files to mitigate rejections due to CPT code.  We also recommend sharing this information with your claims vendor to facilitate any necessary modifications to their system. Please follow the link for more details.