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    Early Intervention

    Third Party Insurance Denials and Public Consulting Group

    Announcement Number: EI 13-05
    Issue Date: 04/30/2013
    Effective Date: 04/30/2013
    Audience: Infant Toddler Early Intervention Programs

    Purpose

    The purpose of this announcement is to provide direction and guidance to infant and toddler early intervention (EI) programs on the availability and utilization of Public Consulting Group (PCG) in obtaining Third Party Insurance (TPI) denials in facilitating the use of Medical Assistance (MA) funds. This announcement updates and replaces Announcement: EI-07 #13.

    Background

    EI services are not covered by third party insurance. However, to meet the requirements related to MA billing, infant and toddler EI programs are required to obtain TPI information from families whose children receive MA for securing and documenting the TPI denial of coverage to bill MA for EI services.

    As of July 1, 2012, PCG will obtain TPI denials for infant, toddler and preschool EI programs. PCG will contact the various insurance carriers throughout the Commonwealth and verify the carrier does not cover EI services. The subsequent listing of TPI denials is posted on the PCG website with regular updates.

    Discussion

    In an effort to promote efficiency and ultimately increase the volume of MA utilization, infant and toddler EI programs should continue to adhere to the following protocol for ensuring TPI denials for children who receive MA:

    1. Obtain third party insurance information from families to include: name of insurance carrier, contact address for the insurance carrier and number for the insurance carrier.
    2. View information on the PCG website to verify that a TPI denial has been obtained for the insurance carrier. Document the denial in the child’s record.
    3. If the insurance carrier is not listed, the infant and toddler EI program must forward the TPI information items listed in #1 above to ra-ocdintervention@pa.gov with the subject heading “New TPI Denial.” OCDEL staff will then forward this insurance carrier information onto PCG. PCG will use this information to obtain the TPI denial and forward a confirmatory email to OCDEL. Subsequently, OCDEL will notify the requesting infant and toddler EI program, via email, that the insurance carrier has been added to the listing.

    Next Steps

    1. Infant and toddler EI programs should ensure the information in this announcement is available to all service coordination staff.
    2. Infant and toddler EI programs should review the PCG’s website supporting the TPI denials.

    Comment and questions should be directed to the Office of Child Development and Early Learning, Bureau of Early Intervention Services at 717-346-9320 or ra-ocdintervention@pa.gov.

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