Transcription of Insurance Service Coordination Tool Kit
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Insurance Service Coordination Tool Kit
Revised October 2019 NEW YORK STATE DEPARTMENT OF HEALTH BUREAU OF EARLY INTERVENTION Insurance Tool Kit for Service Coordinators Tool Kit Items: 1. Initial Service Coordinator Insurance Responsibilities 2. Ongoing Service Coordinator Insurance Responsibilities 3. Collection of Insurance Information Form A 4. Child Insurance Information Form B 5. Authorization to Release Health Insurance Information Form C 6. Request for Coverage Information Form D 7. Instructions for Ongoing Service Coordinators: Collecting the Written Referral from Parents or Primary Health Care Practitioners 8. Written Referral from Primary Health Care Practitioner Form E 9. Parent Notice Regarding Insurance 10. ITEM 10 Form F- Has been removed- no longer applicable 11. Required Notice of Subrogation Sample 12. Guidance on Billing Medicaid for Children enrolled in Medicaid Managed Care Plans 13.
with the child’s Individualized Family Service Plan (IFSP), including service coordination and evaluations. This is inclusive of children that are uninsured. i. If a child is uninsured, the service coordinator is responsible for assisting the parent in identifying and applying for benefit programs for which the family may be eligible
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