EARLY INTERVENTION S DESCRIPTIONS BILLING …

1 EARLY INTERVENTION SERVICE DESCRIPTIONS , BILLING CODES AND RATES EARLY INTERVENTION PROVIDER HANDBOOK Illinois Department of Human Services Community Health and Prevention Bureau of EARLY INTERVENTION September 1, 2009 TABLE OF CONTENTS ii. PRINCIPLES OF EARLY 1 IMPORTANT EARLY INTERVENTION POLICIES AND 2 ASSISTIVE TECHNOLOGY (DURABLE MEDICAL EQUIPMENT AND SUPPLIES) .. 7 AUDIOLOGY, AURAL REHABILITATION AND OTHER RELATED 9 DEVELOPMENTAL 12 FAMILY TRAINING AND 14 HEALTH CONSULTATION .. 17 MEDICAL SERVICES (DIAGNOSTIC/EVALUATION PURPOSES ONLY) .. 18 20 22 OCCUPATIONAL 23 PHYSICAL 25 PSYCHOLOGICAL AND OTHER COUNSELING 27 SERVICE 29 SOCIAL WORK AND OTHER COUNSELING 31 SPEECH LANGUAGE 33 35 36 38 ATTACHMENT 1: EARLY INTERVENTION SERVICE REPORT ATTACHMENT 2: NATURAL ENVIRONMENTS REQUIREMENT AND WORKSHEET.

2 57 ATTACHMENT 3: DEVELOPMENTAL JUSTIFICATION OF NEED GUIDELINES AND ATTACHMENT 4: USE OF ASSOCIATE LEVEL ATTACHMENT 5: REQUIREMENTS FOR PROFESSIONAL AND ASSOCIATE LEVEL EARLY INTERVENTION CREDENTIALING AND ENROLLMENT TO 6: PROCEDURE TO ORDER ATTACHMENT 7: NON-BILLABLE ATTACHMENT 8: APPROVED ASSESSMENT ATTACHMENT 9: EARLY INTERVENTION PUBLIC AND PRIVATE INSURANCE USE DETERMINATION ATTACHMENT 10: EARLY INTERVENTION BILLING ATTACHMENT 11: EARLY INTERVENTION ASSISTIVE TECHNOLOGY ii. Illinois Department of Human Services EARLY INTERVENTION Service DESCRIPTIONS , BILLING Codes and Rates Introduction Thank you for your interest in becoming an enrolled provider with the Illinois EARLY INTERVENTION (EI) Services System to serve eligible infants and toddlers under age three and their families. Following are the Principles of EARLY INTERVENTION , Important Policies and Procedures, service DESCRIPTIONS in alphabetical order showing BILLING codes, modifiers if required, and rates.

3 In addition, please review the DEFINITIONS section of important terms used throughout the document. Additional references are in the attachments as outlined below. Please read this document and all attachments, carefully. If you do not fully understand this information, please contact the Bureau of EARLY INTERVENTION at 217/782-1981 for technical assistance. Attachment 1: EARLY INTERVENTION Service Report Guidelines and Format Attachment 2: Natural Environments Requirement And Worksheet Attachment 3: Developmental Justification Of Need Guidelines And Worksheet Attachment 4: Use Of Associate Level Providers Attachment 5: Requirements For Professional And Associate Level EARLY INTERVENTION Credentialing And Enrollment To Bill Attachment 6: Procedure To Order Eyeglasses Attachment 7: Non-Billable Activities Attachment 8: Approved Assessment Instruments Attachment 9: EARLY INTERVENTION Public And Private Insurance Use Determination Guidelines Attachment 10: EARLY INTERVENTION BILLING Guidelines Attachment 11: EARLY INTERVENTION Assistive Technology Guidelines The EARLY INTERVENTION program utilizes the PRINCIPLES OF EARLY INTERVENTION for service delivery.

4 All approaches to service delivery are based upon the unique needs of each child/family and focus on the coordination of both developmental and therapeutic activities to ensure that all members of the team involved in a child s INTERVENTION , including the family and/or caregiver, are working together. The following philosophy applies to EARLY INTERVENTION : $ The family is viewed as the primary interventionist in a child s life and the expert in relation to the needs of the child and family. $ The family and service providers involved in a child s INTERVENTION establish a working partnership based on an open exchange of information and expertise. $ Developmental and therapeutic activities are incorporated into a child s everyday life to naturally emphasize the acquisition of functional skills. If You Have Below are resources you may find useful if you have questions about the EARLY INTERVENTION Services System.

5 DHS -Bureau of EARLY INTERVENTION The Department of Human Services (DHS), as the lead agency for EARLY INTERVENTION in Illinois, has established the Bureau of EARLY INTERVENTION to administer the statewide EARLY INTERVENTION Services System. Questions concerning the system, or the service DESCRIPTIONS , BILLING codes and rates should be directed to the DHS Bureau of EARLY INTERVENTION at 217/782-1981. You should access the DHS EARLY INTERVENTION website at for current information and documents that pertain to EARLY INTERVENTION Policy and Procedures. ii. Provider Connections Provider Connections is the credentialing/enrollment office for the EARLY INTERVENTION Services System. The EI credentialing and Central BILLING Office enrollment processes begin at Provider Connections. If you need credentialing/enrollment forms or have questions regarding form completion, call Provider Connections at 800/701-0995 for assistance or access their website at You will also find current information and documents that pertain to EARLY INTERVENTION Policy and Procedures on the Provider Connections website.

6 Illinois EARLY INTERVENTION Training The Illinois EARLY INTERVENTION (EI) Training Program provides training and professional development opportunities to individuals and agencies who provide services to Illinois' birth to three EARLY INTERVENTION population. Training is provided in both workshop and video formats. The EI Training Program co-sponsors and provides EI credentialing hours for additional training events held by other training entities, develops a quarterly training newsletter and maintains a training website at or you may contact the Illinois EI Training Program at 866/509-3867, Illinois EARLY INTERVENTION Central BILLING Office The EARLY INTERVENTION Central BILLING Office (CBO) is the claims processing entity for the EARLY INTERVENTION Services System. The CBO makes payment determination on claims submitted by EI providers based upon authorized services and DHS guidelines.

7 The CBO also submits and reconciles the monthly EI Medicaid claim to the Illinois Department of Healthcare and Family Services, provides data to assist CFC s to complete an initial verification of family insurance benefits, maintains the family fee system, administers the collections process, is a source of data collection for DHS, provides technical assistance to families and providers and administers the EI Insurance Unit, which bills insurance on behalf of providers. The CBO also maintains the EI Provider data base. Upon enrollment with the CBO providers will receive a welcome letter that will provide many answers to questions that may be encountered. For more information about the CBO please visit the CBO website at Illinois Department of Human Services Central BILLING Office - Cornerstone Call Center The EARLY INTERVENTION Central BILLING Office is supported by the Illinois Primary Health Care Association Cornerstone Call Center.

8 The Call Center operates Monday through Friday from 7 to 5 Call Center staff, in conjunction with Central BILLING Office staff, are trained to answer questions for providers and families regarding the service authorization process, BILLING inquiries and family fees. Providers receive a welcome letter upon CBO enrollment that will provide many of the answers to questions you might encounter. You can reach the Call Center at 800/634-8540. For more information you can visit theCBO website at Illinois EARLY INTERVENTION Clearinghouse The Clearinghouse provides library and information services to residents of Illinois interested in EARLY INTERVENTION issues. The project provides access to a large lending library of books, videos and articles and is a free resource to access information on health, educational, disability and developmental concerns of infants and young children.

9 Other Illinois libraries are available through interlibrary loan. For more information contact the Clearinghouse toll-free at 877/275-3227 or visit the interactive web site at ii. Illinois EARLY INTERVENTION Monitoring Program The purpose of the EARLY INTERVENTION Monitoring Program is to ensure that state and federal regulations regarding the delivery of Illinois EARLY INTERVENTION services to infants and toddlers birth to three are met. All EARLY INTERVENTION Monitors have extensive knowledge of EARLY INTERVENTION policy and procedure. The Monitoring offices are located in Homewood and Springfield and operate Monday through Friday from 8:00 to 5:00 Copies of all current forms utilized during the review process and frequently asked questions can be found on the Monitoring website at For more information contact the Monitoring Program at 800/507-5057.

10 1 PRINCIPLES OF EARLY INTERVENTION 1) The primary goal of EI is to support families in promoting their child s optimal development and to facilitate the child s participation in family and community activities. 2) The focus of EI is to encourage the active participation of families in the therapeutic process by imbedding INTERVENTION strategies into family routines. It is the parents who provide the real EARLY INTERVENTION by creatively adapting their child care methods to facilitate the development of their child, while balancing the needs of the rest of their family. 3) EI requires a collaborative relationship between families and providers, with equal participation by all those involved in the process. An on-going parent-professional dialogue is needed to develop implement, monitor, and modify therapeutic activities. 4) INTERVENTION must be linked to specific goals that are family-centered, functional, and measurable.