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Benefits and Eligibility
Billing Errors
Corrected Claims
EOB/EOP
General
HRA/HSA/FSA
Payments and Reconciliation
Reports
Voided Claims




Benefits and Eligibility [Back to Top]
Q:Does PCG verify eligibility?Answer
A: PCG does verify eligibility. PCG can verify eligibility, if there is an option to verify eligibility with our trading partner. If PCG cannot verify eligibility, please contact the insurance company to verify eligibility.

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Q:What should I do when claims reject or deny because of eligibility issues?Answer
A: Work with the Service Coordinator, and the family. Review the information that is in Spider. Ask the family member if there have been any changes to the insurance information. Add an end date to the invalid insurance record and add a new insurance record with the correct information and the effective benefits date as the added date. Save the record once you have added the information. Notify PCG support if previous claims need to be resubmitted to the new insurance.

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Billing Errors [Back to Top]
Q:What if I am unable to resolve an issue in the workable claims queue?Answer
A: Contact PCG support at 1-844-293-0023 and provide the claim information that you are unable to resolve. If the issue can be resolved, PCG will provide assistance to help you resolve the issue. If PCG cannot resolve the issue, PCG will move the claim to the next payment source.

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Q:Why is there a claim in EI Billing in ORIGINAL status and has not been paid by private insurance, Medicaid or Escrow?Answer
A: This is because there is an issue with the visit data PCG received and EI Billing is unable to apply a billed rate to the claim, which will allow the claim to move to the initial payment source. (i.e. 1-Time Consultations should not be selected. Instead select ei service.)

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Corrected Claims [Back to Top]
Q:Can a corrected claim be sent to a payment source?Answer
A: Yes, if you find that a claim that was billed and paid incorrectly, a replacement claim can be sent as a corrected claim. For additional assistance with claim corrections, contact PCG support at 1-844-293-0023 and provide the claim information that is paid incorrectly. Keep in mind, PCG may ask that you void the visit in the case management system and create a new visit with the accurate information.

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EOB/EOP [Back to Top]
Q:When I receive an EOB/EOP that is not in EI Billing what should I do?Answer
A: Contact PCG support at 1-844-293-0023 and provide the EOB/EOP or fax the EOBs to Fax: 860-955-1480 or 860-955-3528

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General [Back to Top]
Q:How do I request to add a new insurance company?Answer
A: Contact PCG support at 1-844-293-0023. Provide the support rep with a front and back copy of the insurance card and that you want to add the insurance company.

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Q:How do I reset my password?Answer
A: From the log in page https://bac.prod.cteihub.com/ locate and select "Forgot Password". When prompted, provide the information to reset your password. If you still have trouble resetting your password, contact PCG support at 1-844-293-0023.

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Q:Where can I get a list of CPT and HCPCS codes used to bill early intervention claims?Answer
A: Go to Help > Information > For Provider. Locate 'Birth to Three CPT and HCPCS Codes and Rates' and select Details.

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Q:Where can I look up a child in EI Billing?Answer
A: Go to Reports > Claiming > Child Lookup.

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Q:Where do I add new users in EIBilling?Answer
A: Go to Maintenance an select User List. Click on the Add User button. Type in the preferred Username, First Name, Last Name and Email Address. The user will receive an email with a link containing a temporary password.

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Q:Who can I contact if someone needs training on the EI Billing application?Answer
A: Contact PCG Support at 1-844-293-0023 and provide the name and contact information of the person and indicate the new person needs training on EI Billing.

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HRA/HSA/FSA [Back to Top]
Q:What should I do if insurance has made payments from a consumer health spending account?Answer
A: End date the insurance record in the case management system. If the parent is requesting payments be reversed work with the lead agency and contact PCG at 1-844-293-0023. Provide the claim information that have the issue. Disclaimer: PCG cannot guarantee the insurance company will reverse the payments back to the financial institution that hosts the consumer health spending account. Please inform the family they will need to follow up with the insurance company and financial institution that hosts the consumer health spending account.

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Payments and Reconciliation [Back to Top]
Q:What happens if I discover a payment discrepancy in EI Billing vs. what is provided on an EOB/EOP/electronic remittance, or what the agency was paid?Answer
A: Contact PCG support at 1-844-293-0023 and provide the documentation indicating the discrepancy. PCG will review and update the billing record as applicable. As needed, PCG will consult with the lead agency if further research is needed regarding the appropriate action.

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Q:What should I do if a claim was over paid by escrow?Answer
A: If a claim was over paid by escrow funds, contact PCG support at 1-844-293-0023 and provide information about the claim that was over paid by escrow.

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Q:When I receive a notice from private insurance to return a payment, what is the process to return the payment?Answer
A: Follow the instructions of the notification letter. Additionally, you can check with the insurance company to see if they offer a solution where the payment is deducted from future payments.

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Q:Why is a claim in EI Billing not paid by escrow?Answer
A: If the sum of payments from private insurance and Medicaid = 100% of the billed amount, there is not a balance for escrow to pay. If you determine there is a balance due after private insurance and Medicaid payments, contact PCG support at 1-844-293-0023 and provide the claim information that was not paid in full. Additionally if a claim is not payable by escrow, it is because timely filing limits have lapsed or the visit was entered in the case management system, after the agency administrator signed and approved the service delivery invoice. PCG will make attempts to send the claim to an insurance source but is unable to approve escrow payment without consent from the lead agency.

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Reports [Back to Top]
Q:Where can I find the escrow payments in EI Billing?Answer
A: Go to Reports > Financial > Escrow Checks.

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Q:Where can I go to find private insurance payments?Answer
A: Several report links have information about private insurance payments in EI Billing. You can refer to Insurance 835 Remittance Details, Insurance 835 Checks, Billing History, Visit Payment Summary, Provider Payment Summary, Provider Payment Profile, Posted EOBs.

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Q:Which report should I use to review a list of services that are paid by escrow each month?Answer
A: Refer to the Summary by Service Type Report located under Reports then Summary Reports. Choose the dates in the From Date and To Date filters, then select "Escrow" from the Date Filter drop down list. Next select View Report.

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Voided Claims [Back to Top]
Q:How do I void a claim? Answer
A: Start with B23 case management system. Void the visit in the case management system, then create another visit with the accurate information. Check with PCG to ensure the insurance claim was appropriately voided with insurance and escrow.

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Q:What if I voided a visit in the case management system, but the payment is not voided in EI Billing?Answer
A: Contact PCG support at 1-844-293-0023 and request that the insurance claim be resent back to the insurance company as a voided claim. PCG will resend the claim to the insurance company in attempts to reverse the payment. In the event the insurance company does not reverse the payment, you will need to contact the insurance company and request that the payment be reversed.

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