Understanding Pre-Insurance Billing Waivers In Early Intervention Services: A Guide For Parents And Providers

The Early Intervention program provides free Insurance Billing Services for providers and children participating in the program. The Insurance Billing Unit was created in 2008 to assist Early Intervention providers in maximising insurance payments. The unit consists of coders and insurance professionals who generate claims on behalf of registered providers for submission to commercial insurance companies for payment determination. The service is currently open to newly referred children only and to small businesses that employ seven or fewer providers. The Insurance Billing Unit has knowledge of all current federal laws for billing and can save time for providers.

Waivers for specific providers and services

The Early Intervention program provides free Insurance Billing Services for providers and children participating in the program. The Insurance Billing Unit was created in 2008 to assist Early Intervention providers in maximising insurance payments. The unit consists of coders and insurance professionals who generate claims on behalf of registered providers for submission to commercial insurance companies for payment determination.

The Insurance Billing Unit Service is open to newly referred children only and to small businesses that employ seven or fewer providers. The service is entirely free to currently enrolled and/or credentialed Early Intervention Providers. It helps to save time for providers and maximise insurance payments. The unit has knowledge of all current federal laws for billing and can handle claims status follow-ups, appeals, and secondary claims.

The Early Intervention Central Billing Office (EI-CBO) is responsible for processing Benefit Verification (BV) requests and issuing waivers or exemptions. A BV should be submitted within 30 days of the annual notification of new insurance or possible insurance termination. A 45-day exception is applicable when a family has a change in insurance coverage, allowing time for providers to obtain benefit coverage details for the new insurance or policy change. During this time, providers are expected to complete any pre-authorisations, pre-certifications, and registrations required by the insurance policy.

Waivers are provider-specific and cannot be used to cover services provided by another agency, even if the type of service remains the same. For example, a waiver issued for Social Work cannot be used to cover Psych services. In the event of a provider change, the Service Coordinator must submit a waiver request for the new provider to the EI-CBO, and the provider is required to give a 30-day notice to the Service Coordinator.

Waivers can also be issued for specific types of equipment. For instance, if a participant has insurance coverage but there are no out-of-network rates and no other providers are available in the area, a waiver can be obtained for specific authorisations for equipment. In this case, a separate waiver is needed for each procedure code authorised.

The EI-CBO will enter a post-billing waiver if, upon processing a claim, there are no errors, and the insurance Explanation of Benefits (EOB) clearly indicates that the service is not covered or that the maximum benefits have been met.

Benefit verification requests to the Early Intervention Central Billing Office

The Early Intervention Central Billing Office (EI-CBO) is a free service that helps providers and children participating in the Early Intervention program to maximise insurance payments. The EI-CBO is open to newly referred children and small businesses with 7 or fewer providers.

Benefit Verification (BV) requests should be submitted to the EI-CBO within 30 days of the annual, upon notification of new insurance, upon notification of possible insurance termination, to request waivers or exemptions, to respond to EI-CBO requests for information, and to inform EI-CBO of unique circumstances.

The EI-CBO website is a source for important program notices, billing information, the Early Intervention Provider Handbook, and other program-related items. It provides printable forms and instructional documentation for Child and Family Connections agencies. Participants can access family fee-related material and a variety of early childhood development resources.

The EI-CBO also has an Insurance Billing Unit, consisting of coders and insurance professionals who generate claims on behalf of registered providers for submission to commercial insurance companies. The Insurance Billing Unit is entirely free to use and helps to save time for providers. It has knowledge of all current federal laws for billing and can handle claims status follow-ups, appeals, and secondary claims.

The EI-CBO also has an electronic billing option called QClaims, which is free, easy to use, and HIPAA-compliant. QClaims reduces the time from claim submission to provider payment and eliminates the cost of postage and envelopes.

The role of the service coordinator

Service coordinators play a vital role in assisting families in navigating the early intervention process and accessing the services their children need. They are responsible for coordinating and facilitating the delivery of early intervention services, ensuring that families understand their rights and options, and helping them make informed decisions. Service coordinators often act as a liaison between families and various service providers, including healthcare professionals, therapists, and educators. They help families identify the specific needs of their children and develop individualized plans to address those needs. This may involve conducting initial assessments, connecting families with the appropriate service providers, and facilitating communication between all parties involved.

One of the key responsibilities of service coordinators is to help families understand the financial aspects of early intervention services. They provide families with information about the costs of services, payment options, and available funding sources. Service coordinators explain the process of billing insurance companies and assist families in navigating the often complex world of insurance claims and reimbursements. They help families understand their insurance policies, including coverage limits, exclusions, and any applicable waivers. Service coordinators also support families in exploring alternative funding sources, such as Medicaid or other public benefits programs, if private insurance is not available or does not cover the full range of needed services.

Additionally, service coordinators are responsible for obtaining and documenting relevant information from families to support the billing and reimbursement process. This includes gathering insurance coverage details, such as policy numbers, insurance providers, and benefit packages. They also assist families in providing the necessary documentation to insurance companies, such as medical records, evaluations, and treatment plans. Service coordinators work closely with insurance billing units or early intervention central billing offices to ensure that claims are submitted accurately and in a timely manner. They stay up to date with current federal and state laws related to billing and insurance requirements, advocating for families' rights and ensuring compliance with relevant regulations.

Furthermore, service coordinators play a crucial role in facilitating communication and collaboration between families and early intervention service providers. They help families understand the importance of early intervention and the potential benefits for their children's development. Service coordinators also provide ongoing support and guidance to families throughout their journey, addressing any concerns or challenges that may arise. This may include helping families transition between different services or connecting them with additional resources in the community. Service coordinators often act as a source of emotional support for families, empowering them to advocate for their children's needs and make informed decisions about their care.

In summary, the role of the service coordinator is essential in helping families navigate the complex world of early intervention services. They provide families with the information, resources, and emotional support they need to make informed decisions about their children's care. By coordinating services, facilitating communication, and assisting with insurance and billing processes, service coordinators play a vital role in ensuring that children receive the necessary early intervention services to support their development and well-being.

The Early Intervention Program's free insurance billing services

The Early Intervention Program (EIP) offers free insurance billing services to providers and children enrolled in the program. The Insurance Billing Unit was created in 2008 to assist Early Intervention providers in maximising insurance payments. The unit consists of coders and insurance professionals who generate claims on behalf of registered providers for submission to commercial insurance companies for payment determination.

The Insurance Billing Unit Service is free of charge and currently only accepts newly referred children and small businesses that employ seven or fewer providers. The unit has knowledge of all current federal laws for billing and can help providers save time and maximise insurance payments.

The Insurance Billing Unit can handle all aspects of the insurance billing process, including:

• Registering providers and the children they serve
• Coding encounters based on information from the rendering service provider
• Preparing and submitting private insurance claims
• Following up on claims status
• Submitting any requested information to insurance carriers to assist in accurate claims processing
• Preparing and submitting appeals to insurance carriers
• Preparing and submitting required secondary claims to the Central Billing Office (CBO)

In addition to these services, the Insurance Billing Unit can also assist providers with obtaining benefit coverage details, pre-authorisations, pre-certifications, and registrations that may be required by the insurance policy.

The Early Intervention Program also provides guidance on claiming commercial insurance and Medicaid for early intervention services. This guidance includes information on the responsibilities of service coordinators, evaluators, and general service providers, as well as parents, in the process of claiming commercial insurance and Medicaid. The guidance also covers topics such as subrogation, co-payments, deductibles, and insurance denials.

The process of claiming commercial insurance

• Contact Your Insurance Provider: Get in touch with your insurance provider as soon as possible and inform them about the situation. Explain what happened and provide details about any damage or losses incurred.
• Submit a Claim: Fill out a claim form with your insurance company, providing all the relevant information about the incident. This is where detailed notes, photos, and videos of the incident will come in handy. Attach any supporting documentation, such as police reports (if applicable) and witness statements.
• Adjuster Assignment and Investigation: After submitting your claim, an adjuster will be assigned to your case. The adjuster will review and investigate your claim to assess the extent of the damage and determine what is covered under your policy. They may visit your business to inspect the damage or request additional information.
• Policy Review: The adjuster will carefully review your insurance policy to determine what is and isn't covered and inform you of any applicable deductibles.
• Damage Evaluation: To accurately evaluate the damage, the adjuster may hire appraisers, engineers, or contractors to provide expert advice. They will help assess the necessary repairs or replacements.
• Settlement Offer: Based on the adjuster's findings and the terms of your policy, the insurance company will make a settlement offer. Review this offer carefully and negotiate if you believe it doesn't fully cover your losses.
• Payment: Once a settlement is agreed upon, the insurance company will arrange for payment. They will typically send a check within a specified timeframe, such as 30 days after the claim is settled. You can use this payment to cover repairs, replace lost items, or address any financial losses incurred due to the incident.

It is important to note that the specific steps and timeframe may vary depending on the insurance company and the complexity of the claim. Additionally, each insurance company may have its own requirements and procedures for filing claims, so it is essential to review your policy and understand the claims process beforehand.

Frequently asked questions