1. Does DSCC support the services of a primary care physician?
2. Does DSCC support the use of therapy assistants?
3. Who does DSCC recognize as the "managing physician"?
4. What is DSCC policy regarding the use of Health Care Professionals?
5. How does DSCC work with the Department of Public Health (DPH) to insure babies who fail newborn screening receive free diagnostic services?
6. What is the hierarchy of payment when a child is covered by insurance and DSCC?
7. Does DSCC recognize specialty centers and teams?
8. How can I find out what DSCC reimburses for a service or item?
9. How does DSCC support youth transitioning to adult care providers?
1. Does DSCC support the services of a primary care physician?
Yes. DSCC will support the services of a primary care physician who assists the DSCC specialist with specified portions of the treatment plan at the community level. In addition, pediatricians and family practice physicians may enroll as Medical Home providers. Medical Home providers can be reimbursed for eligible services provided to DSCC children. Specfiic information including CPT codes used to bill for medical home services is listed in our "Reimbursement Guidelines for Medical Home Services" brochure available on the Provider page. Please contact your local regional office for more information.
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2. Does DSCC support the use of therapy assistants?
Yes. DSCC will support the services of a therapy assistant to assist a DSCC approved therapist to complete specified portions of the plan when approved by the DSCC managing specialist. It is expected that the approved therapist complete all reports and submit billing.
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3. Who does DSCC recognize as the "managing physician"?
DSCC uses the term "managing physician" to mean the DSCC approved physician who is directing the specialty care needed by the DSCC eligible child. Any DSCC approved physician can be considered a "managing physician".
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4. What is DSCC policy regarding the use of Health Care Professionals?
It is the policy of DSCC to use the most qualified health care professionals available. All physicians & certain other medical and dental specialists must meet DSCC criteria for licensure, training, experience & liability insurance coverage.
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5. How does DSCC work with the Department of Public Health (DPH) to insure babies who fail newborn screening receive free diagnostic services?
DSCC has a collaborative agreement with DPH to provide free diagnostic services for newborns who fail hearing screening or metabolic screening for certain inborn errors of metabolism and cystic fibrosis. Diagnostic testing for metabolic disorders and cystic fibrosis is provided by DPH consultants who are enrolled with DSCC. Diagnostic testing for hearing loss is performed by DSCC approved audiologists with special expertise in the testing of newborns. Please contact your local office to ask about a specific condition and DSCC coverage.
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6. What is the hierarchy of payment when a child is covered by insurance and DSCC?
DSCC is the payer of last resort. Insurance benefits must be maximized before DSCC can process a claim. DSCC does not supplement other governmental programs, such as AllKids and Medicare.
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7. Does DSCC recognize specialty centers and teams?
The DSCC Medical Advisory Board reviews applications for DSCC approved specialty teams and centers. These include cardiac, cochlear implant, ambulatory surgery centers, epilepsy surgery center, cleft lip/palate, craniofacial, and selective posterior rhizotomy teams. DSCC works with nationally approved cystic fibrosis centers and hemophilia centers. Please visit the "criteria" section on our Provider page for specifics on each team or contact Tess Rhodes, RN, at 800-322-2722 for more information.
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8. How can I find out what DSCC reimburses for a service or item?
Please contact our Central Administrative Office, Claims Services Unit, at 800-322-3722 and provide us with the billing CPT, HCPCS or ADA code(s). The Claims Services staff will provide the most current DSCC reimbursement. Rates are reviewed annually based on regional and national fee surveys, customary provider charges for service, geographical, and Resource Based Relative Value Schedule (RBRVS) data.
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9. How does DSCC support youth transitioning to adult care providers?
DSCC has dedicated staff to empower youth and their families with the knowledge and tools necessary to plan for the transition from pediatric doctors to adult doctors, moving from school to work, and achieving the highest level of independent living. Our transition specialist, Ms. Darcy Contri, RN, provides outreach and education to physicians and community partners. DSCC professional staff located in thirteen regional offices throughout the state work directly with families and youth in transitioning to adult care providers and planning for the future. We are committed to our families and will actively work with physicians to promote a smooth transition of services from pediatric to adult settings.
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