OCDEL Update on Mass Claims Adjustment: Next Steps for Failed Claims

The Office of Child Development & Early Learning notified all County Early Intervention (EI) programs and providers regarding next steps for past claims that failed the auto-correction to update payment to the new rate approved for 2025–26.

As expected, there were many ICNs that failed the Mass Claims Adjustment. The Bureau has prepared a document for each EI program to distribute to their contracted providers. The document includes the provider’s name, the original ICN that did not successfully mass adjust, and the Error Status Codes (ESC) that prevented the claim adjustment. EI Programs should work together with providers to resolve these claims errors. After successful resolution of the claims error, providers will be responsible for performing their own claims adjustment for the claims that failed the Mass Claims Adjustment.

Next Steps:

1. EI County Programs can access their document within DocuShare using these instructions: OCDEL – Bureau of Early Intervention Services- Infant/Toddler & Preschool General Information – PROGRAM NAME – Adhoc Query Results.
2. EI county programs should immediately download the file and share each provider’s information separately. DO NOT forward the entire document to all providers.
3. EI providers and county programs should work together to resolve the claims errors.
4. EI providers will submit their own claims adjustment according to timelines. It is recommended that claims are prioritized by date of service, focusing on July and August claims first and then moving to claims later within the 2025/26 fiscal year.

Resource documentation regarding ESCs that resulted in the failed Mass Claims Adjustment is available by accessing the Learning Management System within this course: PELICAN EI Provider: Financial Management.

Moving forward:

1. Using the newly published Fiscal Year 2025/26 Fee Schedule – file NEW claims on or after 3/9/26 that contain a date of service on or after 7/1/25.
2. Using the newly published Fiscal Year 2025/26 Fee Schedule – adjust claims filed on or after 3/9/26 that contain a date of service on or after 7/1/25 if the OLD fee schedule was used.

IMPORTANT REMINDER:

OCDEL reminds providers of the timely filling of all claims. The regulation at 55 Pa. Code § 1101.68 (relating to invoicing for services) establishes requirements for submitting claims for services rendered. Early Intervention evaluations, IFSP services, and Service Coordination claims are all required to follow this regulation.

1. A provider shall submit original or initial invoices to be received by the Department within a maximum of 180 days after the date the services were rendered or compensable items provided.

Resubmission of a rejected original claim or a claim adjustment shall be received by the Department within 365 days of the date of service.