Kentucky's CBIS

Overview:

All early intervention services in Kentucky are billed through a Central Billing and Information System (CBIS) and payments are made by the state from a pool of multiple fund sources. All providers of early intervention services sign a Provider Agreement with the state. This agreement enrolls the agency and each staff person in the agency that is providing early intervention services, or enrolls the individual if the person is an independent provider. Enrollment in the provider network authorizes them, if approved, to bill the First Steps (Kentucky’s Early Intervention System) program. State rates are established in regulation and all providers bill accordingly.

Information Flow: The Central Billing and Information System (CBIS) has four information components.

Provider: Upon enrollment, the provider's qualifications are checked, including agency/independent requirements and individual licensing/certification requirements. When approved, the provider's information is entered into the CBIS database.

Demographic: Fifteen district Points of Entry (POE) provide intake and child find services. When a referral is appropriate, an initial service coordinator transmits basic demographic information to CBIS and authorizes initial services. If, after visiting the family, it is appropriate to proceed toward provision of services, the initial service coordinator transmits additional demographic information, including eligibility. After the Individualized Family Service Plan (IFSP) is developed a primary service coordinator assumes responsibility for the family and updates demographic information.

IFSP: After the IFSP has been written, the initial service coordinator transmits IFSP information on authorized services, including frequency and intensity, to CBIS and it is entered into the system. The primary service coordinator updates the information in each subsequent IFSP.

Billing: After services are provided the approved provider bills CBIS. The claims are entered into the system by CBIS

Processing: Thereare two steps to processing.

Matching: The provider submitting the claim must be an approved provider in the system, the claim must be for a child determined eligible by the POE, and the services must match an authorized service on the IFSP. Mismatches are returned to provider, and if appropriate, corrected and resubmitted for processing.

Transmittal for Payment: CBIS claims are submitted to the state Cabinet for Health Services finance division for processing and payment out of a pool of funds comprised of state general revenue, Part C, and Medicaid. The Cabinet transmits the payment approval to the state Treasury which pays the claims. Medicaid eligible claims are simultaneously transmitted by the CBIS to Medicaid for processing through MIS and payment of approved claims to the pool.

Data and Information Use:

Payments for all services are processed through CBIS and the information on all services are stored.

Monitoring reports on service activity for a sample of children are produced and taken on-site to match documentation with service provision.

Surveillance reports on service patterns can be produced and reviewed at any time for agency or individual providers.

Management reports are routinely produced. On a bimonthly basis, expenses are compared to revenues and projections made for fiscal year expenditures. Bimonthly reports shows numbers of children served, percentage of Medicaid utilization, and expenditure patterns. Other administrative reports are available as needed. Annually, summaries of year-end expenditures, cost per child, cost per service, year-by-year growth comparisons, etc. are available. CBIS provides data for required federal reports.

Legislature members and staff can request reports on program demographic profiles, summary expenditure data, etc. at any time. Information on constituent complaint resolution is also available.

Additional Characteristics:

Central processing of bills allows the program to establish and enforce practice guideline limits that prevent excessive service provision over and above early intervention program obligations. Central collection of data allows implementation of a statewide family fee system. Centralized payments according to statewide rates establishes equity across geography, programs, and disciplines. Centralized pooling of funds maximizes utilization of multiple fund sources, lowers distribution cost, and eliminates distribution formulas and other grant contracting difficulties. Central Billing and Information System (CBIS)