A: Great question! The billing process can be a little confusing, and there are several reasons why a practitioner may not appear on the YTD report.
We do pull billing information directly from the SEIS Service Tracker; however, successful billing also depends on several additional factors, including:
- Services have not been entered into the SEIS Service Tracker
- The practitioner's credentials or NPI are missing or not on file
- ORP (Ordering, Referring, and Prescribing Practitioner) information is missing for applicable treatment services
- Services are not linked correctly to the student's IEP, or the student's Medi-Cal Parent Consent is marked "No," preventing claims from being submitted for billing
- Providers have not yet submitted their service logs. While providers have up to one year to submit claims, it is considered best practice to submit documentation promptly so the YTD report accurately reflects services provided.
- The student is not currently Medi-Cal eligible
If you would like, I would be happy to schedule a meeting to review specific practitioners and determine why billing may not be occurring for certain providers.