Pathfinder Health Innovations develops innovative all-in-one software solutions to help therapists and special education teachers deliver lessons to individuals with autism and other developmental disorders. We enable therapists and teachers to use the power of advanced data analysis to significantly improve social and developmental outcomes. Our premiere billing and insurance reimbursement service dedicated to autism service providers will ensure you get paid on time.

Based in Kansas City, MO, Pathfinder Health Innovations was formed in 2010 by technology experts with guidance from autism professionals, and has grown to serve therapy centers and school districts across the United States.

Using Pathfinder Health innovation’s software, therapists and teachers plan lessons, collect data in real-time, automatically graph the results, and then analyze the data to determine the best path for the child’s progress.

  • Plan – Pathfinder Health Innovations helps therapists reduce their session planning time by using our Artificial Intelligence tool to recommend next steps for therapy implementation.
  • Collect – Therapists can use paper or any web-enabled tablet to collect data in real-time, and control the consistent implementation of therapy to the client.
  • Graph – In seconds, therapists can see the results of their work, giving the most accurate, up-to-date information on a child’s progress.
  • Analyze – Pathfinder Health Innovations helps therapists determine when a child has mastered a skill, and when he or she needs more work. In addition, the software helps assess the therapy team’s performance, ensuring consistent therapy implementation. The software is fully HIPAA and FERPA compliant, ensuring safety and security for patient records kept in the system.

While Pathfinder Health Innovations comes with a basic protocol, our Implementation Team works with teachers to implement whatever curricula or therapy protocols they prefer. Our goal is to minimize disruptions to therapy delivery, while using Pathfinder Health Innovations as a workflow engine to drive consistency, focus and productivity with paraprofessionals.

Results will vary, but our customers report Pathfinder Health Innovations cuts administrative time almost in half. The saved time can then be spent on the children in their care.

Beyond time savings, therapists and teachers have experienced increased control over therapy delivery, immediate data collection insights, and improved focus on the individual’s progress.

One of Pathfinder Health Innovation’s core goals is to drive improved outcomes for individuals with autism. In 2012, Pathfinder Health Innovations conducted a pilot study with University of Kansas researchers that demonstrated that teams using Pathfinder Health Innovation’s software helped children increase their rate of skill acquisition by up to 20 percent. This kind of dramatic improvement in their social and developmental skills can lead to students with autism being more active participants in school and social activities.

Pathfinder Health Innovation’s team is composed of therapy and special education practitioners and technology experts. We augment our knowledge with a Scientific Advisory Board led by some of the top minds in autism therapy. Finally, we seek continuous improvement from our customers, implementing their suggestions into the software and making it an industry-leading solution.

Absolutely not. We have always taken the position that we will provide you with information, but it is your role as a therapist to decide what to do with that information. The Pathfinder Health Innovations system uses an Artificial Intelligence engine to examine evidence-based practices and a child’s unique history to RECOMMEND skills for you to use in therapy. You have the full control to add or remove skills as you see fit. The benefit is that you no longer have to look through a list of 400 skills to determine the next Echoic skill for your patient to learn. By doing this, therapists on our system are saving 70% of the time they used to spend in session planning. In addition, Pathfinder Health Innovations RECOMMENDS maintenance skills, so you no longer have to solely rely on memory to periodically check for mastery retention. We leave the art and science of therapy to you; we just give you the tools to make it better.

Yours. Pathfinder Health Innovations comes a core set of 250+ skills built on ABA curricula protocol to which additional skills can be added. Also available are prep-populated curricula for Eden Autism Services’ Early Intervention, School and Adult protocols. As an alternative, Pathfinder Health Innovation’s Implementation Team will work with you to import your unique set of skills, ensuring you can continue to offer your therapy, your way.

No, but a number of our staff members are experienced therapists and special educators. In addition, we chose to seek advice from BCBAs throughout the country. Some of them serve on our Scientific Advisory Board. This allows us to gain insight from the BCBA’s expertise, while not obliging us to a specific therapy protocol or methodology. Our intention is to support multiple therapy methodologies and curricula, allowing you to offer your therapy, your way.

No. Pathfinder Health Innovations software is available on various web-enabled tablets (including iPad, Android, and Microsoft Surface tablets) as well as any laptop or desktop computer. As an alternative, you can print out data worksheets, collect data, then enter information into the system at the end of the day in less than 5 minutes. The cool thing is that both methods are very easy to understand and use!

Pathfinder Health Innovations is fully HIPAA compliant, hosted in a secured environment and accessed with a secured log-on to ensure the privacy of patient profiles and information. Information that may be made available to authorized researchers is scrubbed of all individual identity information.

When working with children, the therapist records the child’s responses using a tablet device such as an iPad or Android. This information is fed into Pathfinder Health Innovations and is used by the system to create progress reports and lesson plans. As an alternative, you can print out data worksheets, collect data, then enter information into the system at the end of the day in less than 5 minutes. We hope this document has been helpful. For additional information or other questions you may have, please contact us at 877-9-Pathfinder.

PHI currently works with businesses in the following states:

  • Arizona
  • California
  • Colorado
  • Connecticut
  • Florida
  • Georgia
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Maine
  • Massachusetts
  • Michigan
  • New Hampshire
  • New York
  • Ohio
  • Oregon
  • Pennsylvania
  • South Carolina
  • Texas
  • Utah
  • Virginia
  • Washington
  • Wyoming

Even if we don’t currently work in your state, PHI is able to assist you. Contact us now for a free consultation.

PHI will track the authorized units or time frame of the authorization and give warnings when you’re reaching a limit. This is accomplished by setting up your contracts on the front end of the PHI platform and entering specific client authorizations.

PHI is not involved in your transactions of receiving money from insurance companies. Arrangements for payment must be setup with the insurance company. Please read your contract carefully.

PHI doesn’t take any money that insurance pays out. You are invoiced for our agreed percentage rate.

PHI offers support and training on our platform, please review your specific contract for any possible fees that may occur.

There is the ability to export to excel from the PHI system.

PHI offers a one-click electronic claims submission process. Because of our direct connect with Optum Clearinghouse, claims are transmitted to the insurance carriers on an hourly basis.

Once the claim is submitted to the insurance carrier, it is dependent upon your states clean claim processing rules. For more information, we suggest you check your states department of insurance website.

All data in Pathfinder is encrypted while in motion from the server to the front-end client. The application and associated data is housed in Microsoft Azure’s cloud infrastructure, and replicated across multiple data centers. Should a failure occur, the system will transfer control from the affected data center, to a functional center. This is seamless to the end user and ensures continuous access to the system is maintained.

No, each insurance plan has their specific rules to cost shares. Some can be per service day, some per specific services or billing codes, and some are applied after a deductible or out of pocket max have been met. We suggest that you ask the carrier specifically based on the clients benefits and the codes you will be billing. Call the carrier and as an example ask, “For a H2019 15-minute code, what is the dollar amount the family will be responsible for?” They should be able to tell you based on the benefits available for your clients/patient what the allowable is for the code, what they will pay to you, and what the client/patient cost-share would be.

Not always. Caps typically do not kick in until a client’s/patients Out of Pocket Maximum (OOPM) is met, and this is usually outside of the deductible amount required. Even then, the carrier may request a cost share. Ask the carrier if the cost-share is dropped or reduced after the deductible and OOPM is met, or if there are any other circumstances in which the cost-share would be completed/dropped.

You are. Even as a non-network provider the Explanation of Benefits (EOB) you receive should tell you if any of the service amount was applied to the patient/clients deductible or not. Deductibles can be for multiple services, so even though you bill, others do too and any of those services can be applied to the deductible based on the plan. Call and ask a customer service representative at the insurance company how much the deductible is, and how much has already been met. Review your EOB’s and look for the info there as well. As a business decision, you can always request/require a family to let you know if/when the deductible is met. We recommend that you get it in writing if you are going to bill the client/patient based on a deductible, and make them responsible to alert/inform you when it is met.

Whatever your contracted rate is, the insurance company will pay that amount with the reduction of the co-pay which is due from the patient/client. It does not matter what you bill as long as it is equal to or more than your contracted rate. If you are to be paid $150.00 per your contract, and you bill dollar-for-dollar (get paid $150.00 so you bill $150.00) for a service, and the client/patient’s co-pay is $20.00, you will get an EOB that says something like: Billed Amount: $150.00, Allowed amount: $150.00, Patient Co-pay $20.00, total paid to provider $130.00. If you bill as a base fee, the same applies but you would do a “contractual adjustment” for the difference in the billed amount and allowed amount.

Are you a Medicaid Provider? If you are a contracted Medicaid Provider, then yes you are required to bill the secondary payer after the primary payer has paid or denied a claim. Nine times out of ten, the primary insurance (BCBS/Aetna/Cigna) pays MORE than Medicaid’s fee schedule allows. Meaning; if you bill an S5108 for $100.00 and the primary (say Aetna) pays $80.00 and there is a $20.00 co-pay due from the client/patient, if you are a contracted provider you could bill Medicaid as a Secondary insurance to pay the co-pay due from the client/patient. However, if Medicaid’s Fee Schedule lists an S5108 to be reimbursed at say, $58.00, you have already received MORE than Medicaid allows for that same service. So, Medicaid would explain that in an EOB, and because you are a Medicaid provider of service, you CANNOT bill the family for that co-pay and are required to adjust it off.
**If you bill a primary insurance for a service/code, you have to bill that SAME service/code to the secondary. This is pertinent because not all of the Medicaid waiver codes match the insurance benefits and codes being billed. The codes have to match in order to bill the primary and then bill the secondary. Please be certain to ask Medicaid for the specific bill codes you will be billing to them after the primary pays their share, to ensure they are covered codes by Medicaid – if they are not, you CAN bill the family for a co-pay.

Yes, Health Savings Accounts should have no differences than private pay scenarios, it’s just an option to use different funds for payment of services.

No, the only way a provider can bill a client after paid by insurance is if they are out of net since they don’t have a contract or if the carrier says that the amounts are, “Patient Due” / “Patient Responsibility.” If a carrier is reducing payments/rates that were not agreed to in the provider contract, the provider needs to take that up with the carrier, as the patient/client would have nothing to do with it.

Because every insurance company has different rates depending on each contract, you would work with our Senior Consultant to assist with those credentials. If your contract is not on the PHI platform, we will get the information from you and personally enter it in to ensure the process runs smoothly as you submit claims.

The American Medical Association has some of the best information to refer to and help with the transition. Click here to visit their website.