1
Provider authorized
service delivered
Fiscal Workflow for Implementing EI Budget Reforms
April 2013
Attachment B
Provider authorized
service delivered
EI Provider Service Authorization
Provider Claims
3
Submit Claims
Paper & 837
Submission
(KIDS)
Submit Claims
Online
(NYEIS)
Submit Claims
837 File Submission
(NYEIS)
4
$ Payment
2
KIDS
Data System
KIDS
7
4A
$ Payment
Business
Rules
&
Edit
Checks
Business
Rules
&
Edit
Checks
Payments for partial
non- covered services
Provider Payments not covered by Third Party Payout
State share – 49% back to municipality
Bi- Weekly report on payment owed
for non- covered services
Remittance
State Fiscal
Agent
Claim
$ Payment
Muni share
Escrow
Account
Remittance
Claim
5
Municipality
Muni deposit to cover 100%
owed to providers
(3) Report to DOH
6
Commercial
Insurance
Medicaid
8
State contributes state share
(lag remains in effect)
100% County funds in first instance
$ Payment
12/28/12