Billing Providers encountering situations which delay the ability to submit claims on a timely basis may enter an Extraordinary Circumstance (EC) in the EI-Hub's Billing Module. The EC represents the reason that claims could not be submitted within the Bureau’s timely filing guidelines. ECs are entered once for the entire date range the billing provider was affected and must be entered before submitted any claims for the affected time period. For more information, including a job aid on how to enter ECs, follow the link above.

Medicaid revised its denial reason for files processed and paid in November and replaced denial code CO200 with CO31. Providers will begin seeing CO31 denials in their Workable Claims queue within the Billing module. No action is required from providers at this time. To support this change, PCG is implementing a system update that will automatically move CO31-denied claims to Escrow, using the same methodology previously applied to CO200 denials. Follow the link for more information.

Claims that are sent to Medicaid must have an OPRA (Ordering/Prescribing/Referring/Attending) enrolled referring provider. Medicaid will deny claims billed with a referring who is not OPRA enrolled (including Speech Language Pathologists). It is the responsibility of the agency to confirm the credentials and proper Medicaid enrollment for all referring providers utilized on claims prior to billing.

New resources are now available in the Learning Management System, covering service authorizations and claiming for transportation and respite services. This article includes direct links to these resources—follow the link for more information.

An In The Loop article titled “Entering Commercial Insurance in the EI-Hub” released on 03/20/2025 provides guidance on entering commercial insurance. The article notes that commercial insurance companies often have multiple billing addresses for claims. However, with Covered Lives legislation, only the insurance company's name is required in the EI-Hub. Follow the link for more information.

1099 forms have been mailed to providers who received payments for Early Intervention services during the 2025 calendar year. Providers may receive multiple 1099s from the State Fiscal Agent, Medicaid, and insurance companies, subject to the $600 threshold. Follow the link for more information.

Follow the link to review the 2026 Escrow Reimbursement Calendar.

The Early Intervention Program (EIP) is pleased to announce that the 4% rate modifier for eligible EI services in Underserved and Rural areas is now in effect as of December 23, 2025, and will apply prospectively to new claims payable from municipal escrow. The first escrow payment that the 4% rate modifier will be applied is for checks payable on January 7, 2026. Follow the link for more information.

The EI-Hub Full Release was successfully deployed to the Production environment on December 11, 2025. Detailed release notes of the work items in this update are available in the Learning Management System (LMS). You can access them using the link provided above.

The Early Intervention Program (EIP) is pleased to share Frequently Asked Questions (FAQs) related to the 4 Percent rate modifier for Underserved and Rural areas of the State, that was approved by the Centers for Medicare & Medicaid Services (CMS) on September 25, 2025. Follow the link for more information.