Private Insurance Billing For Providers of Early Intervention Services

This resource has been designed to provide helpful information to alleviate the fears associated with seeking insurance/third-party reimbursement. By reading the text and following the instructions as provided for filing claims, one can be very successful in receiving payment.

Resources for data gathering in regard to the types of insurance/third-party funding available are pointed out. Providers interested in accessing insurance will want to have an understanding of the variety of health-coverage plans available. The description of private insurance, HMOs, self-funded plans, and other government plans in this chapter will be helpful not only funding purposes, but also as the provider/service coordinator consults with parents.

It outlines documentation requirements of insurance carriers and HMOs for the initiation and continuation of treatment, provides information regarding procedure codes and diagnostic codes and the tools providers will need to use.

A step-by-step approach for completion of the basic HCFA/CMS-1500 claim form, which is used for private insurance, HMOs, and government plans other than Medicaid.

And finally, we will outline the life cycle of a claim from gathering the data for services rendered to recording the payment. The reimbursement and evaluation process of the billing system is also discussed.