Indiana Part C First Steps. Indiana Part C  Serve over 17,000 kids per year  Central finance system  Over 2,000 providers (both independent and agency)

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Presentation transcript:

Indiana Part C First Steps

Indiana Part C  Serve over 17,000 kids per year  Central finance system  Over 2,000 providers (both independent and agency) enrolled through the state  Direct service cost is over $45,000,000 per year  Lead agency is a Family and Social Services Administration (FSSA) with 10 dedicated early intervention staff positions

Payment of Service  Reimbursement is Fee for Service  Provider claims are submitted electronically through the Central Reimbursement Office (CRO)  Providers bill utilizing HIPAA compliant CPT codes to describe services delivered  Maximum state rates are utilized when determining reimbursement  Pay and chase method of reimbursement

Revenue Sources  Medicaid  TANF  Federal Part C  State allocation  Title XX  Title V  Cost Participation  Insurance

Billing Private Insurance  Handled by a Third Party Biller  Claims are batched meeting HIPAA requirements  Insurance recovery offsets family co-pay  Insurance waivers are provided per parent request

Lessons Learned  No easy answers  Don’t expect quick results  Involve your providers- you need BUY-IN  Have providers identify CPT codes that best represent the services delivered through your program  System must support diagnosis codes (ICD9) related to the service  Insurance billing takes time and effort