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Indiana

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

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Indiana

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  1. Indiana Part C First Steps

  2. 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

  3. 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

  4. Revenue Sources • Medicaid • TANF • Federal Part C • State allocation • Title XX • Title V • Cost Participation • Insurance

  5. 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

  6. 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

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