Providers

The information we offer here is intended to be of interest to physicians, health professionals and healthcare vendors who serve children with special health needs.

New Web Site for Parents of Children who are Deaf or Hard of Hearing

Illinois Sound Beginnings website is a parent-friendly website designed to provide information to families of children who are deaf or hard of hearing. The website provides general information regarding hearing loss and intervention. In addition the site gives state specific resources for families. Visit the website at www.illinoissoundbeginnings.org.

Families and Health Professionals Partner to Give Children A "Medical Home"

If you want more information about how families and professionals can work together to provide comprehensive coordinated care for children with special health care needs, you will want to learn more about a Medical Home. We have developed a web-based slide show with video clips to help explain what a medical home is, and how it can help to establish a beneficial partnership for families and professionals.

The show will open in a new browser window - close the window to return to this page. You will need the free Real player to view the video clips. (The show includes accessibility options for those using screen readers.)

Want more information about Medical Home initiatives?

• DSCC has developed Creating a Medical Home: the foundation for primary care delivery that comprehensively introduces the medical home concept, explains how the model is being implemented within Illinois and provides links to related web-based materials. We hope this information offers busy primary care providers a menu of suggestions that can be incorporated into their practice and helps improve the quality of health care delivered.
  
  
• The Medical Home Primer for Physicians is available in PDF format and includes the CME exam and Program Evaluation form. You will need the Adobe Reader to view and print it. The Reader is available free from the Adobe web site.
  
  
• A web-based slide presentation defines the concept of the Medical Home and how DSCC will integrate this new approach to care coordination within the organization's routine operations. The Medical Home structure and treatment team is defined and each team member's responsiblities outlined. The Illinois Implementation Plan, the Promise to the State, outlines the plan of action for DSCC and other vested organizations and state agencies to see the Medical Home system change implemented.

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Join the Provider Directory for Children with Special Health Care Needs

A statewide resource for locating pediatric health care providers in Illinois and the surrounding border states is now available online. The provider directory has search features which enable users to locate providers by their area of specialty, the type of health care services they provide, or based upon their geographic location.

Providers who serve children with special health needs are invited to become directory members. Specialty providers listed in the directory include pediatricians, family physicians, pediatric specialists, occupational therapists, physical therapists, speech pathologists, audiologist, pediatric dentists and others.

Membership is free and easy! To complete an online application and establish a member listing, go to the Illinois Provider Directory for Children with Special Health Care Needs website.

Or, you can use this printable application form. This form can be completed online, printed and then faxed to our office. Instructions are available to explain how to complete pdf forms on-line. Upon receipt of your completed application, we will enter the information for you and notify you via email. The form is in PDF format - you will need the Adobe Reader to view and print it. The Reader is available free from the Adobe web site.

Members have complete control over the information provided in their directory listing and can change their information, at any time, by logging into the directory and modifying their member listing. This is a free service; the only requirement is an e-mail address. All communication is managed via e-mail.

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Transition: Tools for Physicians
Although many young people with special health care needs are able to find their way into and negotiate through adult systems of care, there is a substantial number of adolescents and young adults with severe medical conditions and disabilities whose successful transitioning from child to adult health care depends on more deliberate guidance. Physicians have an important role in facilitating transitions to adulthood and to adult health care for young people who are least likely to do it successfully on their own. For many young people with special health care needs, this will mean a transfer from a child to an adult health care professional; for many others, it will involve an ongoing relationship with the same provider but with a reorientation of clinical interactions to mirror the young person’s increasing maturity and emerging adulthood.
(excerpt from A Consensus Statement on Health Care Transitions for Young Adults with Special Health Care Needs; Pediatrics Vol 110 No. 6 December 2002, pp. 1304-1306.)

Two resources have been developed to assist health care providers supporting young adults' transition to adulthood: The Transition Information Sheet for Medical Care Providers provides pertinent background information about medical transition and provides strategies for effective transition planning. The Transition Checklist and Timeline outlines important issues to assess and address during key periods of adolescence. These tools are intended to be guidelines and must be individualized to meet the specific needs and developmental skills of each young person.

The Illinois chapter of the American Academy of Pediatrics has developed a resource for physicians and other health care providers working to assist young adults transition to adulthood. The brochure, Teen Transition Facts for Health Professionals, is full of information and suggestions that will help health care professionals provide meaningful support and assistance.

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Frequently Asked Questions

A list of frequently asked questions (FAQs)is available to answer the questions most commonly asked by providers of health care services. Should the information needed not be listed, please feel free to contact us through our feedback form or by e-mail. Our e-mail address is: dscc@uic.edu.

Medical Articles

The National Library of Medicine (NLM) Gateway is a premiere resource for access to a vast array of medical information. The Gateway allows users to search in multiple retrieval systems at the U.S. National Library of Medicine. The NLM Gateway offers an abstract on many journal articles. Full journal articles can be obtained from any library that carries the journal containing the article, or through Loansome Doc.

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Becoming a DSCC Approved Provider

DSCC has an obligation to assure children with special health care needs receive quality medical management and treatment.  DSCC has established  a process to meet this obligation.  The approval process confirms certain providers of health care services have appropriate specialized training, experience, and certification in the care and treatment of children with special health care needs.

The Approval Process:

Physician specialists and other professionals must meet discipline specific criteria, carry professional liability insurance in amounts appropriate to their specialty, and agree to abide by DSCC policy and procedures to participate and receive reimbursement for services provided to DSCC patients. Similar criteria exist for the approval of providers of equipment, nursing agencies, hospitals, and specialized treatment centers.

Primary Care Physicians as Medical Home Providers
Primary care physicians (pediatricians and family physicians) can now become DSCC-approved Medical Home Physicians and receive reimbursement for eligible services provided to children enrolled in the DSCC Core program. Medical Home Physicians have a trusting, collaborative relationship with families and provide care that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally competent. We have devoted a section of our web site to introducing and explaining the Medical Home model for primary care physicians.

• A Medical Home Provider brochure has been developed to explain the medical home concept and the criteria for becoming an approved Medical Home Physician.
• Completion of the Medical Home CME Monograph is part of the provider approval process. Confirmation of completion is accomplished by submission, via mail or fax, of the program evaluation form.
  
  Each form is in PDF format - you will need the Adobe Acrobat Reader to view and print them. The Reader is available free from the Adobe web site.

DSCC recognizes that serving children with special health needs is often more complex and time consuming. Medical Home Physicians will be reimbursed when the level of decision-making or planning complexity requires more physician time. Reimbursable services may include telephone consultations with specialists and certain care coordination activities not otherwise covered by third party payers. More specific information is available in the DSCC Reimbursement Guidelines for Medical Home Services brochure. If you have any questions, or would like more information about becoming a Medical Home Physician, please contact DSCC.

Provider Approval Criteria outline the specific requirements for physicians, specialty teams and centers, and other health care providers to become approved for providing reimbursable services to children enrolled in the DSCC Core program.

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Provider Application Forms

If you would like to apply to become a DSCC Approved Provider, you will need to complete the following forms and mail them to DSCC.

DSCC providers can fill-in and print completed forms from our web site, print blank forms and complete them manually, or contact a DSCC Regional Office to receive them by regular mail. Instructions are available to explain how to complete pdf forms on-line. The Adobe Reader, available free from the Adobe web site, is needed to view and print these PDF files.

Note: Adobe Reader does not allow you to save completed forms to disk; the ability to save completed forms is available commercially with the Adobe Acrobat 3.0 (or later) product suite.

• Professional Training and Experience Form

• Taxpayer Identification Number and Legal Status Disclosure Certification

Complete and submit only one (1) of the following:

• Professional Insurance Statement
  (for Physicians only)

• Professional Insurance Statement
  (for all other health care providers)

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DSCC Reimbursement Policy:

DSCC serves as a guarantor of payment for services authorized by DSCC. A DSCC authorization document identifies the service provider, site, date(s) of service delivery and specific services to be covered. Copies of the authorization are distributed to the family, physician/provider, and medical institutions when appropriate. Services provided without an approved authorization by DSCC or which differ in any way from those specified in the authorization, unless approved by DSCC, are not guaranteed for payment. By accepting a DSCC authorization, the provider agrees not to seek further payment from the patient or patient's family for charges beyond the amounts payable from third party payers and/or DSCC.

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DSCC Reimbursement Procedure:

Payments for authorized services are processed after appropriate claims have been acted upon by third party payers. DSCC will not pay for services which are covered by Medicaid. Claims exceeding third party payment should be submitted to DSCC and will be considered for payment up to the allowable fee maximum established for the billed CPT (Current Procedural Terminology) or ADA (American Dental Association) codes. When third party payments exceed the DSCC fee maximum, the bill will be considered paid in full.

Charges submitted for services and supplies must include the date of service and the appropriate ICD-9 diagnostic code for which the service or supply was provided. In addition, Current Procedural Terminology (CPT) codes, HCPCS National Level II codes, American Dental Association (ADA) codes, or National Drug Codes (NDC) are required on billings for respective services.

The DSCC fee schedule is based upon information received from regional and national fee surveys, and is updated periodically upon the recommendation of the Medical Advisory Board. Procedures found to be unexpectedly and/or unusually complex will be reviewed for adjustment of reimbursement upon written request to the Director. Such requests should accompany the billing and clearly demonstrate the complexity of the service which is not reflected in the available CPT code descriptors.

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Provider Forms Available for Download
DSCC has developed several treatment forms to help approved providers document the treatment and care provided to children enrolled in the DSCC Core program. These forms cue for the information needed to effectively coordinate care and approve medical authorization.

DSCC providers can fill-in and print completed forms from our web site, print blank forms and complete them manually, or contact a DSCC Regional Office to receive them by regular mail. Instructions are available to explain how to complete pdf forms on-line. The Adobe Acrobat Reader, available free from the Adobe web site, is needed to view and print these PDF files.

Note: Acrobat Reader does not allow you to save completed forms to disk; the ability to save completed forms is available commercially with the Adobe Acrobat 3.0 (or later) product suite.

Newborn Screening Forms:

• IDPH Newborn Genetic Screening Program Diagnostic Evaluation Form (form 3.44)
  
• Order Form for Newborn Hearing Screening program materials (form 17.18)
  
• Newborn Hearing Screening Program Diagnostic Evaluation (form 3.45)
  
  English:
  
  
• Newborn Hearing Screening: Information for Parents (form 43.00)
  
• Newborn Hearing Screening: Instructions for Parents (form 43.01)

  Español:

• Exámenes Preliminares De Audición para Recién Nacidos en Illinois: Información para los Padres (form 43.00S)
  
• Prueba de Audición Universal para Recién Nacidos en Illinois:Instrucciones Importantes para los Padres (form 43.01S)

Polski:

• Program skriningu sluchu noworodków w stanie Illinois: Informacje dla rodziców (43.00P)
  
• Program skriningu sluchu noworodków w stanie Illinois: Wazne instrukcje dla rodziców (43.01P)
  

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Core Program Forms:

Instructions are available to explain how to complete PDF forms on-line. The Adobe Acrobat Reader, available free from the Adobe web site, is needed to view and print these PDF files.

Note: Acrobat Reader does not allow you to save completed forms to disk; the ability to save completed forms is available commercially with the Adobe Acrobat 3.0 (or later) product suite.

• Therapy Treatment Plan (form 5.27)
  
  
• Pediatric Ophthalmic Report (form 5.26)
  
  
• Physician Recommendation for Hearing Aids
  (form 5.32)
  
  
• Evaluation/Training for Use of Equipment
  (Vendor form - 5.33-2)
  
  
• Evaluation/Training for Use of Equipment
  (Therapist form - 5.33-3)
  
  
• FACT Sheet: DSCC Support of Power Mobility Bases/Wheelchairs
  (05.30)
  
  
• Power Mobility Base/Wheelchair Parent Questionnairre
  (form 05.31)
  
  
• Power Mobility Skills Checklist
  (form 05.34)
  
  
• Power Mobility Evaluation Template
  (form 05.35)

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Home Care Program Forms:

Instructions are available to explain how to complete PDF forms on-line. The Adobe Acrobat Reader, available free from the Adobe web site, is needed to view and print these PDF files.

Note: Acrobat Reader does not allow you to save completed forms to disk; the ability to save completed forms is available commercially with the Adobe Acrobat 3.0 (or later) product suite.

• Price Estimate for Medical Equipment & Supplies (53.33)
  Home Care Providers must complete this form annually, and whenever major changes in the child's equipment & supplies occur. The estimated cost of prescribed equipment and supplies must be submitted to ensure the child's medical plan of care remains cost effective. Providers can electronically complete this form and submit it, via fax, to the regional office coordinating the child's care. Or, the form can printed and completed manually.
  
  
• Nursing Agency Billing Form
  The Home Nursing Services Billing Form (55.12) is available in 2 formats: Microsoft Word and PDF (Adobe Portable Document Format).
  
  
• Nursing Supervisory Summary Form
  The Nursing Supervisory Summary Form (55.08), or a similar form containing the same information, is required from the nursing agencies every 60 days. This information is provided to the Department of Healthcare and Family Services. It is available in 2 formats: Microsoft Word and PDF (Portable Document Format).
  
  

  Nursing Agencies can fill-in and print completed forms from our web site, print blank forms and complete them manually, or contact the DSCC Call Center toll-free at 877-791-5170 to receive them by regular mail.

Want More Information?

More information is available in the DSCC Reimbursement and Billing Guidelines for Providers. This brochure is provided in PDF format - you will need the Adobe Acrobat Reader to view and print it. The Adobe Reader is available free from the Adobe web site.

You can also contact the DSCC office nearest you for additional information.

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