ECI Guide for Billing Targeted Case Management ... - ABC Signup

ECI Guide for Billing Targeted Case Management Services to Medicaid
1. Is the child eligible for ECI
No
Yes! Proceed to
question 2
2. Is the child enrolled in or potentially eligible for Medicaid
No. Activity is not billable to Medicaid, but check if
case management is reimbursed by child’s insurance
Yes! Proceed to
question 3
3. Did the parent decline ECI Case Management Services
No! Proceed
to question 4
Yes
4. Was the case management activity provided by a qualified Service Coordinator
No
Yes! Proceed to
question 5
5. Did the activity occur in the presence of the child’s parent or routine caregiver
(face to face or telephone)
No
Yes! Proceed to
question 6
9/2011

6. Was the main focus of the activity to benefit the child (Examples below)
Assessing the child and family needs (scheduling discipline specific evals after
ECI eligibility has been determined, RBI)
Developing or revising the IFSP
Referral for services that directly benefit the ECI child (social, medical,
developmental or educational services).
Related service for a referral (Setting up medical appointment, transition
visits, etc.)
Monitoring the IFSP
No
Yes! Proceed to
question 7
7. Does the documentation of the case management activity meet the requirements
outlined in ECI Rules
Yes!
Proceed to
question 8
No.
Documentation must
support case
management activities
that will be billed.
8. Did it take 8 minutes or more to perform the billable case management activity
Yes
No.
Case management
activities must be
8 minutes or more to bill
Medicaid
Billable Case
Management
Non-Billable Case
Management
Document accurately the time spent on “TCM” in the child’s record. Case
management activities provided are billed in 15-minute increments--don’t forget
the rounding rules.
9/2011