The federal law requires that early intervention services that are reimbursable by Medicaid, insurance or any other appropriate payer source, must be billed by the provider for reimbursement. For any service that has no other possible payer, Part C funds can be used to reimburse the service at the CMS State Early Steps/Medicaid rate. The Local Early Steps Office reimburses for those services according to guidelines which are outlined in the Service Agreement between the provider and SHH/Early Steps.

In order for the Local Early Steps Office to reimburse for services, the service must be authorized on the child’s Individualized Family Support Plan and the provider of the service must be enrolled in Early Steps. If the family has Medicaid or private insurance, a written denial indicating that the service is not covered under the family’s plan must be submitted with the request for reimbursement.

Requests for reimbursement must be submitted monthly and not more than sixty (60) days from the date the service was provided or date of denial/EOB from a third party payer. The Reimbursement Request Form and Service Report Forms for requesting reimbursement are included in the Provider Service Agreement packet. These forms can be provided electronically by the Local Early Steps Office.

FEE FOR SERVICE REIMBURSEMENT SCHEDULE