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:

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.
EI county programs should immediately download the file and share each provider’s information separately. DO NOT forward the entire document to all providers.
EI providers and county programs should work together to resolve the claims errors.
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:

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.

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.

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.

< Previous Post

Next Post >

ODP Updates the MAAC on Paid Relative Caregiving & Travel Limitations

By Tim Sohosky • May 29, 2026

On Thursday, May 28, the Office of Developmental Programs (ODP) provided an update to the Medical Assistance Advisory Committee (MAAC) regarding current policies and upcoming regulatory changes following a recent Commonwealth Court decision. On February 17, 2026, the PA Commonwealth Court issued a decision in Dunkelberger v. Department of Human Services that determined that ODP’s limitations on provider model services (specifically the 40/60-hour caps and 90-day travel maximums) were null and void. The decision was based on process rather than policy validity; the Court found that these limitations were not properly promulgated as regulations in accordance with the Commonwealth Documents Law and Regulatory Review Act. To maintain a balanced approach between flexibility and oversight, ODP is moving forward with the following actions: Regulatory Amendments: ODP will amend regulations to establish formal authority for setting service delivery limits that support individual welfare and program integrity. Self-Directed Model Agreements: ODP has already modified agreements for self-directed models to clarify limits on overtime, combined relative service provision, and travel restrictions. Travel Restrictions: Due to the inability to monitor services effectively over long distances, service provision will now be limited to Pennsylvania and contiguous states. Waiver Changes: ODP will seek modifications through the amendment process to the Consolidated, P/FDS, Community Living, and Adult Autism Waivers to include: New requirements for agencies providing IHCS and Companion services to disclose a DSP's relationship to participants; and Strengthened programmatic oversight and integrity measures. Life Sharing Alternative: For participants requiring more than 60 hours of paid care from a relative, the Life Sharing (24/7) service model remains the recommended alternative. ODP anticipates a public comment period for these proposed waiver changes beginning in January 2027.

Two men with intellectual disabilities working happily on a tablet.

Shapiro Administration's Strategic Investments in ID/A Community Lead to Highest Number of Pennsylvanians Ever Served in HCBS

By Tim Sohosky • May 28, 2026

Press Release from DHS : Published May 27, 2026

ODP Provides Updates to PBC 2026/27 Residential Pay-for-Performance

By Cathy Barrick • May 28, 2026

The Office of Developmental Programs (ODP) has shared ODPANN 26-039 . The purpose of this communication is to provide updated details about the Residential Performance-Based Contracting (PBC) Pay-for-Performance (P4P) initiatives for Fiscal Year 2026/27. Updates are provided in red . Please review the announcement for more details. Visit here to access the Pay for Performance (P4P): Residential Rural Capacity Expansion Plan template .