Satisfacción Prácticas Profesionales

Providers participating in the Early Intervention program are required to bill the Central Billing Office (CBO) for reimbursement for services provided. Listed below is a brief outline of billing procedures. A more-detailed document entitled “Billing Information for Providers” can be found on the CBO website at

www.eicbo.info

Billing Guidelines and Forms

Providers should bill the CBO at their usual and customary rate. The amount billed to the CBO must duplicate the amount billed to the insurance company, if applicable. By signing the EI Provider Agreement, a provider accepting Early Intervention authorizations also agrees to:

• Not bill the family directly for authorized direct services unless the insurance payment was paid to the family versus the provider and you have a copy of the signed “Child and Family Connections Insurance Affidavit, Assignment and Release” form in hand.

• Accept the insurance payment in full unless the payment is less than the EI rate. If the insurance payment is less than the EI rate, bill the CBO the same rate that was billed to the insurance company and the CBO will process payment for the difference in the insurance paid rate versus the EI rate.

• Not bill the family directly or their insurance for screening, evaluation and assessment services or IFSP development. These are services that must be provided at no cost to the family per Federal law (Part C of the Individuals With Disabilities Education Act).

• Maintain accurate records, including daily documentation of services for each date of service billed, including IFSP time, for a period of at least six years from the child’s completion of EI services (please see documentation definition found in the DEFINITIONS section of this document). NOTE: In a monitoring review or audit it is the entity who submits claims and receives payments (payee) for each date of service and each procedure code billed to and paid by the CBO who is responsible for providing documentation for review. Failure to provide documentation will result in a refund. Therefore it would be to the advantage of the payee to require all employee’s or contracted employee’s to submit documentation to support billing and payment prior to submitting claims to the CBO for payment.

Electronic Billing - Electronic billing is the preferred method of claim delivery to the CBO. Claims may be submitted directly to the CBO using the software of the provider’s choice or by sending claims through the Qclaims billing software provided at no cost to the provider. Information on how to sign up for Qclaims is available on the CBO website at www.eicbo.info. NOTE: Electronically billed claims may not be received at the CBO the same day they are transmitted by the provider. Due to the 90 day filing limit, please allow ample time for claims to be received at the CBO.

The CBO will also accept paper claims submitted on the CMS-1500 and UB-04 claim forms only. Refer to the service description for your discipline found in the front of this handbook for the EI payment rates. Transportation Billing Form - Providers and parents who bill for transportation services must use the DHS Transportation Billing Form when submitting claims to the CBO. Insurance is not required to be billed for this service nor is an ICD-9 code required on claim submissions.

Interpreter/Translator Billing – Interpreters must indicate the type of service provided in Box 23 of the CMS-1500 form when submitting claims to the CBO. Insurance is not required to be billed for this service nor is an ICD-9 code required on Interpreter/Translator claim submissions. See the document entitled “Billing Information for Providers” found on the CBO website at www.eicbo.info for more detailed information on Interpreter/Translator billing requirements.

99 Private Insurance Use in Early Intervention

Private insurance use is mandatory in the EI program unless a waiver or exemption has been approved before the start of services. If a child’s family has a primary insurance, it must be billed before seeking further reimbursement from the CBO. When billing a child’s primary insurance all payee’s should bill based upon the providers treating ICD-9 and treating CPT/HCPCS codes. They should not bill based upon information found on the EI IFSP, EI authorizations or from the physician’s medical diagnosis. The primary insurance EOB must accompany all claims submitted to the CBO for further reimbursement and for claims paid in full by the primary insurance.

Time to Bill

Claims must be received by the CBO no later than ninety (90) days following the date of service delivery. For claims where primary insurance is involved, the claim must be submitted along with a copy of the insurance EOB from the primary insurance, no later than ninety (90) days from the date identified on the insurance EOB. The CBO will not use a fax date or computer print out date to determine timely filing. If the primary insurance pays the charges in full, a claim, along with a copy of the insurance EOB, must be submitted to the CBO to ensure posting to the child’s authorization.

Provider Claim Summary

Once a claim has been processed by the CBO, the provider will receive a “Claim Summary” and the family will receive a “Explanation of Benefits” that details all charges billed, paid and denied. Questions with regard to this summary should be directed to the CBO Call Center at 800/634-8540.

Insurance Billing Services

The Early Intervention program provides insurance billing services for providers participating in the program. This insurance billing service is specifically designed to bill primary insurance companies on behalf of the provider for new client referrals only.

Providers will register one time with the CBO insurance billing unit and will submit enrollment and encounter forms for children they wish to obtain the billing services for. The purpose of the

encounter forms is to provide treating documentation that will allow CBO staff to correctly code insurance claim(s) using treating level ICD-9 and CPT/HCPCS codes. Therefore, it is extremely important to submit thorough and accurate documentation on all encounter forms. The CBO will bill the primary insurance company on behalf of the provider and the provider, in turn, will receive insurance payment/CBO payment for the claims submitted.

100

ATTACHMENT 11

EARLY INTERVENTION

ASSISTIVE TECHNOLOGY

GUIDELINES

Please monitor the Provider Connections website at: www.wiu.edu/providerconnections

101