PIC provides early intervention services to eligible children and their families. PIC complies with Part C of IDEA which requires all Alaska Infant Learning Programs to bill all available funding sources to help recover some of the costs of providing services. If your child has both public and private insurance, PIC is required to first bill the private insurance, before billing public insurance.
It is PIC’s practice for all direct services, including Developmental Therapy and Social Work, to create a Plan of Care that aligns with your child’s IFSP services.
Programs for Infants & Children (PIC) utilizes an electronic health record for all Early Intervention services provided by staff across all direct service provider disciplines. PIC’s electronic record has many features and elements that make our documentation and billing procedures fully integrated. Included in this integration is your PIC’s provider(s) treatment plan, or Plan of Care (POC) that is sent to your child’s primary’s physician and your family’s Individualized Family Service Plan (IFSP). The POC and IFSP share the same Long Term Goals. Long Term Goals are created by your family and PIC’s IFSP multidisciplinary team.
The program includes charge tables where each service is listed with the amount of the service. PIC’s charge table is set with Medicaid approved rates. When or if a rate for a code changes, PIC is able to update the table with an effective date for that code. It is PIC’s practice to bill at Medicaid approved rates for all services and for all third-party payers. PIC must bill private insurances prior to billing Medicaid for therapies (OT/PT/SLP).
PIC has health information technicians that bill for services, primarily pediatric therapies. PIC providers document within the electronic record details about the services. Included in documentations are:
Type of services provided:
Occupational, Physical and Speech therapies (OT/PT/SLP), Developmental Therapy and Social Work.
- CPT codes (Current Procedural Terminology: numbers that identify medical procedures/services)
- Date of service
- Time in and time out of services
- Goals addressed/progress on goals
- Plan until next service
The direct service providers e-sign off on their note and submit for billing review. PIC’s health information specialists review the note and if all details are consistent with agency practices, the note is posted to the ledger for billing. Our practice is for policy is to complete documentation within 1 week of the date of service. Notes are typically reviewed and posted for billing within 1-2 weeks of being electronically signed.
Posted notes are sent securely and electronically to our contracted clearinghouse, which then sends a claim to the correct payer/insurance for payment. PIC bills all available payers for the services including Medicaid, when it is the primary payer or secondary.
Consent to Bill Insurance
PIC is required to have consent to bill Medicaid and/or any other insurance company for billable services provided by PIC’s Occupational, Physical and Speech language therapists. When parents sign the Consent to Bill form, they give PIC permission to bill their insurance(s).
PIC does not bill parents for out-of-pocket expenses, like co-pays or deductibles. PIC will accept any payment from the insurance companies as payment in full.
Consent to Bill should be requested annually and if your child has private insurance: any time there is an increase in duration or frequency of services, as well as an additional new billable service added to your child’s IFSP.
It is your decision to give consent to bill and PIC will not deny services if you do not give consent to billing your insurance(s). In regards to billing and treatment by Occupational, Physical, or Speech therapists, PIC also needs permission to share their treatment plans with your child’s primary physician.
If your child does not have any health insurance, your child will still receive services listed on your families IFSP.
Types of Insurance
Public Health Insurance: Medicaid or Denali KidCare, Indian Health Service, Tricare.
Private Health Insurance: usually from the parent’s employer or an individual policies from the healthcare marketplace ‘healthcare.gov’. A few examples are Aetna, Cigna, EBMS and Premera.
PIC attempts to contact all families that have private health insurance and OT/PT/SLP on your child’s IFSP, to briefly discuss general caps and limits according to their policy, and to answer any questions.
Services Available at No Cost to Family
Federal Part C Regulation 303.521(b) states that the following functions must be provided at no cost to families:
- Screening;
- Evaluation/Assessment;
- Family service coordination;
- IFSP development.
PIC appreciates the opportunity to work with your family, regardless of your insurance status. Please do not hesitate to ask any questions you may have.
Questions?
If you have any questions, please call PIC’s main phone number at 907-561-8060 and ask to speak with the billing department.