Re: Digest for delaware-county-providers@googlegroups.com - 1 Message in 1 Topic

[Linda Brennan]

Great job on that letter.  Any higher ups in EI that might take an interest?  They hired this group!   What is going to happen when this changes over to the 'permanent' fiscal agent?  More changes in paperwork?  I am confused about the EOB's.  I didn't need to fill out the chart when I followed the directions on the tutorial about filling in EOB's as it already had all the visits and said 'submitted' under the status line.  But when I Emailed EIbilling about this child, etc, no claims that Excellus could find, they asked me how I could have put in an EOB if I hadn't been paid, yet they told us on the Email that we wouldn't be paid unless the EOB was done.  I am really confused about this EOB stuff.  I cannot find any child account number starting with the letters they indicated.  Think I am going to lose about 3,000 before this is done, just like the rest.

On Mon, Jul 22, 2013 at 5:11 PM, <delaware-cou...@googlegroups.com> wrote:

  Today's Topic Summary

Group: http://groups.google.com/group/delaware-county-providers/topics

• What i sent to my NYS represenatives and the child and family and autism retention commitees [1 Update]

 What i sent to my NYS represenatives and the child and family and autism retention commitees

Libby LePinnet <libbyl...@gmail.com> Jul 22 10:51AM -0700  

As members of the autism retention committee, I would like to bring to your
attention concerns regarding children with autism in NYS.

As of April 1st the state has taken over the early intervention program and
there have been issues. Providers have not been paid by private insurance
since April. This is resulting in many providers leaving the system. This
will severely reduce the hours of services your children and other members
families receive.

Early Intervention could not exist at all without the committed providers
who work hard to provide services each day. Many qualified therapists with
many years of Early Intervention experience have left the program due to
the lack of thought put in by the state prior to the changes in April. The
NYS EI system was rushed and we the providers are taking the weight on our
shoulders. We have been seeing our families for months without payment,
this allows the families to continue receiving services but we remain
unpaid. Many families are not aware of the situation as ethically we
cannot bear the thought of these children not receiving services and we
take the financial hit.......

Because the biggest remaining hurdle in this system is funding through
private insurance companies, I am asking you to please help find a way to
speed the process of denial or payment of claims by the insurance
companies. It would be great if the fiscal agent could pay us from the
escrow account and then the private insurance payment could reimburse the
escrow account. This would prevent those providers who have stayed with the
program from having to deal with months of delayed payment. As of July 22,
2013 I have not received any of over 3000 dollars since April 2013 that is
held up in private insurance.. At this time, we also have no way to handle
claims that have been denied. The interim fiscal agent does not have the
resources to help providers determine where the error has occurred.
Because the permanent fiscal agent does not begin their contract until
October, providers with significant issues in billing will have no hope at
all of payment. Often, these errors have occurred because of incorrect
insurance information entered into the computer system by service
coordinators at the county level who collect intake data, or by incorrect
codes provided to the insurance companies by the fiscal agent. There needs
to be some remedy for this. I personally have a conflict of information in
the system because one number was entered incorrectly into the computer
system by the municipality, I resubmitted my bills but I was not aware of
this for months after my initial April submission. This is the frustrating
part; we can’t hurry up the system. I have called many private insurances
to see if they have received my April bills and they have not or there has
been an error which does not result in a denial (which would allow me to be
paid from the escrow account) just gets sent back to interim fiscal agent
without my knowledge of an error.

Our families need the services but the therapists need to be paid. Please
be aware this effects the families in your district and families all over
NYS.

Thank you,
Elizabeth LePinnet Kelly, PT, DPT


 

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