Billing Third Parties First

Providers and parents or legal guardians must bill all other sources of direct third party payment before submitting their claims to CSHP for payment. Private insurance must be billed and benefits, or the denial of benefits, ascertained TABLE 157 - SLIDING FEE SCALE FOR CSHP SERVICES Percent of Federal Poverty Level Percentage of Cost Sharing Responsibility for Responsible Party Annual Maximum Responsibility Per Client 0% - 185% 0% $0 186% -199% 10% $1,800 200% - 224% 20% $3,600 225% -249% 30% $5,400 250% -274% 50% $9,000 275% -299% 75% $13,500 300% and above 100% $18,000 IDAHO ADMINISTRATIVE CODE IDAPA 16.02.26 Department of Health and Welfare Children’s Special Health Program Section 254 Page 8 before the CSHP will consider payment. Typically either an Explanation of Benefits (EOB) from the third party payor or a letter stating that the service is not covered will be required before CSHP payment will be made. (3-15-22)