Indiana

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
• Dont 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