Early Intervention Program Changes
Effective July 1, 2005

Insurance

The Central Billing Office will administer all Early Intervention program requirements related to insurance including:

• On-going technical assistance for providers on insurance related issues.
• Limited insurance benefit and eligibility verification.
• The review, approval and notification of status on insurance waiver and exemption requests.
• Most waivers will be generated ONLY AFTER initial billing of the insurance.

*The only exceptions are provider related waivers and travel related waivers-for services rendered in center-based settings ONLY!

Billing

• All credentialed providers will be required to bill the family’s private insurance prior to billing the Central Billing Office-this includes Developmental Therapists but does not include Parent Liaisons, interpreters, deaf mentors or transportation providers.
• Beginning July 1, 2005, all developmental therapists will be required to bill insurance before billing the state for all initial and subsequent IFSPs.
• There will be a 120 day transition period to determine insurance requirements, provider limitations, pre-certification mandates, etc. for the current families receiving Development Therapy services. During this time, providers will be able to research insurance company network provisions in their communities and enroll in those plans where they are qualified and could be accepted, which will allow them to serve children in their communities covered by those plans.
• The insurance billing requirement will take effect for all dates of service November 1, 2005 or later for all developmental therapists.
• For dates of service on or after July 1, 2005, provider claims must be received by the CBO within 90 days of the date of service or within 90 days from the last communication from the insurance company.
• The DHS Early Intervention Service Billing Form will no longer be accepted as of service dates July 1, 2005. All direct service providers must bill on the HCFA/CMS-1500 form or UB-92 form. Transportation providers should continue to use the DHS Early Intervention Transportation Billing Form.
• All claims submitted to the CBO MUST specify a valid ICD-9 TREATMENT diagnosis code or they will be denied beginning July 1, 2005.
• There will be a transition period for all developmental therapists with existing caseloads.