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Published by Rick Karlin

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Published by: Rick Karlin on Aug 13, 2013
Copyright:Attribution Non-commercial


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The New York State Department of Health (DOH) today announced it willissue state-funded “safety netpayments” to early interventionproviders in response to provider concerns about the lack of payment of claims submitted to insurancecompanies. The Department’s decisiveaction is in response to a large number of insurance companies’ lack of compliance with recently enacted EarlyIntervention Program reforms.The Early Intervention Program providesservices to children with developmentaldelays aged birth to three. Approximately 69,000 children wereserved in the program in 2011-12 acrossthe state. Services provided includephysical, occupational and speechtherapies and special education.Historically in the program, more than30 percent of enrolled children have
some form of private health insurancecoverage; insurers have paid only 2percent of the costs of services. As partof a series of program reforms enacted April 1, 2013, participating therapistsnow bill insurers through DOH’scontracted fiscal agent. These reformsprovide fiscal and mandate relief for local governments.Since April 1, 2013, under this newsystem, DOH, through its fiscal agent,has issued payments to providerstotaling more than $133 million,including Medicaid and localgovernment funding. Unfortunately,most insurance payments remainoutstanding resulting in cash flowproblems for providers. While nearly400,000 claims have been submitted byproviders to insurers, only about 75,000 – less than 20 percent - have beenadjudicated.
 To ensure providers of early interventionservices receive timely payment,insurers’ prompt response to claims isessential. Payments of any claims – inpart or in whole - are only possible after the insurer adjudicates the claim. Under changes to Insurance Law and PublicHealth Law, insurance companies arerequired to accept claims from DOH’sfiscal agent and issue payments for covered services directly to earlyintervention providers. Regrettably,many insurers have been incorrectlyissuing payments to families or other therapists, not sending the requiredinformation about the results of theclaim adjudication process to DOH’sfiscal agent, or not responding to claimsat all.The Early Intervention Program for infants and toddlers with disabilities or 

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