Early Intensive Developmental and Behavioral Intervention (EIDBI) services offer medically necessary treatment to people under the age of 21 on Medical Assistance (MA) with autism spectrum disorder (ASD) and related conditions.
The purpose of the EIDBI benefit is to provide medically necessary early intensive intervention that targets the functional skills and core deficits of people with ASD and related conditions. As well as:
• Educate, train and support their parents and families
• Promote people’s independence and participation in family, school and community life
• Improve long-term outcomes and quality of life for people and their families
This page covers the following information:
For more information about the EIDBI benefit, see the EIDBI Benefit Policy manual.
In order to provide, bill and receive payment for EIDBI services, a provider must:
• Be enrolled as a Minnesota Health Care Programs (MHCP) provider
• Meet all provider qualifications on the EIDBI assurance statement for the provider type
• Have a DHS-approved service authorization (SA) to provide services for the person
Refer to the Overview of EIDBI providers page in the EIDBI Benefit Policy manual for more information.
To enroll as an EIDBI provider, follow the instructions on the Early Intensive Developmental Behavioral Intervention (EIDBI) Provider Enrollment page. All MHCP providers must register a MN–ITS account.
A person is eligible to receive EIDBI services if he or she meets all of the following criteria:
• Has been diagnosed with autism spectrum disorder (ASD) or a related condition
• Has had a comprehensive multi-disciplinary evaluation (CMDE) that establishes his or her medical need for EIDBI services
• Is enrolled in Medical Assistance (MA) or MinnesotaCare
• Is medically stable and does not require 24-hour medical monitoring or procedures
• Is under age 21
Refer to the Eligibility for EIDBI services page in the EIDBI Benefit Policy manual for more information.
The EIDBI benefit covers the following services:
Only eligible provider types may perform each service. Telemedicine is an option for some EIDBI services. Refer to the EIDBI services page in the EIDBI Benefit Policy manual for more information.
For a list of noncovered services, refer to the EIDBI services page in the EIDBI Benefit Policy manual.
EIDBI does not cover transportation and language interpreter services. As a Minnesota Health Care Program (MHCP) provider, it may be covered through access services. Refer to the MHCP Provider Manual’s Access Services section for more information.
Some EIDBI services require service authorization (SA). The authorization requirement safeguards against inappropriate and unnecessary use of health care services under state and federal law.
The SA allows qualified providers to bill and receive payment from MHCP after providing EIDBI services. However, having an approved SA does not guarantee MHCP payment. The provider must meet all other MHCP requirements to receive payment.
The following services require authorization:
• Family or caregiver training and counseling
• Intervention – individual and group
• 60-day temporary increase of EIDBI intervention services – DHS-7109D (PDF)
• Intervention observation and direction
• ITP progress monitoring (ongoing)
• Travel time
The following services do not require authorization prior to service delivery:
• The initial ITP
• The annual CMDE
• One coordinated care conference per year
Information in this section pertains to fee-for-service MHCP recipients only. If the person is enrolled in a prepaid health plan, contact the appropriate managed care organization for authorization requirements. When people have private insurance, follow the primary insurance’s authorization procedures and other applicable rules.
MHCP’s current medical review agent is Keystone Peer Review Organization (KEPRO). MHCP contracts with KEPRO to process EIDBI service authorization requests.
Note the following timelines in the EIDBI service authorization process:
• Each EIDBI service authorization request cannot exceed a six-month time span.
• Providers should complete and submit a person’s annual CMDE at least 30 but no more than 60 calendar days before the end date of the current service authorization period.
• Providers must complete the initial CMDE prior to the initial ITP. (This means the CMDE and ITP cannot be signed on the same day and the ITP cannot be signed prior to the CMDE.)
• The CMDE provider and legal representative may sign the ITP on the same day. The medical review agent will not accept the CMDE if the date of the legal representative’s signature is prior to the date of the CMDE provider’s signature.
• The QSP and legal representative may sign the ITP on the same day. The medical review agent will not accept the ITP if the date of the legal representative’s signature is prior to the date of the QSP’s signature.
• Kepro may retroactively approve up to six months for services that require authorization. The qualified providers and legal representative must sign the ITP and CMDE prior to delivering any of these services.
The CMDE provider is responsible to:
• Submit the completed CMDE DHS-7108 (PDF), including the CMDE signature page, to the web-based KEPRO Atrezzo portal
• Ensure that all documentation in the CMDE is complete and accurate prior to submission
The QSP provider is responsible to:
• Receive medical necessity approval before submitting the ITP
• Submit the completed ITP DHS-7109 (PDF), including the ITP signature page and the completed "week in the life" page, to the web-based KEPRO Atrezzo portal
• Submit a denial letter or explanation of benefits from the primary insurer if MA is secondary
• Ensure that all documentation is complete and accurate prior to submission
• Coordinate other health, mental health, and home and community-based services to ensure that the person receives services that are the most appropriate and effective in meeting the person’s needs
In general, the EIDBI provider agency is responsible to:
• Use the Atrezzo portal to submit information to and communicate with KEPRO. KEPRO will not accept documentation sent via fax or mail, and the MN-ITS message screen has limited space.
• Providers must reference the KEPRO Atrezzo portal to check the status of the CMDE. Since the annual CMDE does not require authorization, a SA is not created and a notification will not be sent via MN-ITS.
KEPRO will do the following within five business days of receiving the CMDE:
• Verify that all the required components of the CMDE are present
• Pend the case and notify providers through the Atrezzo message inbox if additional information is needed
• Review the documentation and make a medical necessity determination
KEPRO will do the following within ten business days of receiving the ITP:
• Enter information from the ITP and CMDE into Medicaid Management Information System (MMIS)
• Verify all required components of the ITP are present
• Pend the case and notify providers through the Atrezzo message inbox if additional information is needed
• Complete an integrated review process of the CMDE, ITP and other MHCP-covered services the person receives in order to determine authorization for EIDBI services
If KEPRO pends the case in the Atrezzo portal and requests additional information:
• The provider has 20 business days to upload the requested information or make the requested corrections. The provider must submit all the additional information requested at one time to KEPRO.
• KEPRO has three business days from when it receives the additional information to review and make an approval or denial determination.
DHS will send letter notifications to the provider:
• 60 days prior to the annual renewal date for the CMDE
• 60 days prior to the six month renewal date for the ITP
The provider may request:
• An adjustment to an existing, approved service agreement (i.e., “technical change”)
• A temporary increase in EIDBI intervention services above what was recommended in the person’s CMDE or ITP
Technical Change Request
• Instructions on how to complete and submit the technical change request form, DHS-6516
• Examples of how and when to use the form
To request a technical change, complete and submit EIDBI Technical Change Request, DHS-6516 (PDF). See DHS-6515A (PDF) for:
60-Day Temporary Increase in Intervention Services
To request a 60-day temporary increase in intervention services, complete and submit EIDBI 60-Day Temporary Increase Request for Intervention Services, DHS-7109D (PDF). For instructions on how to complete and submit the form, see DHS-7109E (PDF). Within 10 business days of receiving the form, KEPRO will make an authorization determination.
• Additional CMDE within the calendar year
• Additional ITP within the calendar year
• Additional coordinated care conferences beyond the one allotted per year
To request authorization for EIDBI services that exceed the service limit threshold outlined on the EIDBI billing grid (e.g., additional CMDE in a calendar year, additional coordinated care conference in a calendar year, etc.), complete and submit EIDBI DHS-3806 (PDF). For instructions on how to complete and submit the form, see DHS-3806A (PDF). A prior authorization request for these additional services is recommended, however, the medical review agent will accept retro authorization requests for the following EIDBI services only:
Within 10 business days of receiving the form, KEPRO will make an authorization determination.
Contact the KEPRO provider call center at 866-433-3658 or 612-354-5589 for:
• Login credentials
• Portal access
• Questions regarding the current status of submitted cases
• Submit additional documentation on an existing case
• Training on how to create a new case
Refer to the KEPRO website and the MHCP Provider manual Authorization section for more information.
Refer to the EIDBI Billing Grid for:
• Service names
• Procedure codes
• Reimbursement percentage rates
• Provider limits and requirements
• Service limits
Refer to the MHCP Fee Schedule for the most current rate information.
To submit claims for EIDBI services:
• Use MN−ITS direct data entry (DDE) or your own X12 compliance software (batch billing system)
• Use the professional (837P) claim
• Follow the instructions in MN–ITS User Manual Guide – EIDBI Claims
A claim submission must include:
• The pay-to provider
• The procedure code for the EIDBI service provided
• The appropriate modifier(s)
• The UMPI or NPI of the rendering provider who delivered the service (see note below for exception)
• The supervising provider for any services that require the supervision of a QSP
Note: Claims for any services delivered by a Level III provider submitted prior to Jan. 1, 2018, do not require the UMPI number of the rendering provider.
When submitting claims for EIDBI services:
• Bill only for EIDBI services already provided
• Bill only for services approved on the SA
• Do not bill services that require an SA on the same claim as services that do not require an SA
• Submit your usual and customary charges for the service
• Use the most current and specific diagnosis codes
• Use date spans only when you have provided services for all dates in the span
• Only bill codes for “the first 30 minutes” one time per day, per code
• Use place of service (POS) 12 (home) for EIDBI services provided in a community setting, as outlined in the person’s ITP
Tribal providers should refer to the Tribal and Federal Indian Health Services page in the MHCP Provider manual for more information.
Telemedicine via Interactive Video
Use telemedicine billing for eligible EIDBI telemedicine services. Services provided using telemedicine have the same service thresholds, reimbursement rates and authorization requirements as services delivered face-to-face. Bill for services delivered via telemedicine with the modifier “GT.” MHCP does not reimburse for connection charges, or origination, set-up or site fees.
Refer to EIDBI telemedicine services page in the EIDBI Benefit Policy manual and the Physician and professional services – telemedicine page in the MHCP Provider manual for more information.
EIDBI provider agencies that are enrolled in a health plan must follow the managed care organization’s rules and guidelines to bill, obtain authorizations and enroll with the health plan. Refer to the Managed Care Organizations (MCOs) and Prepaid Health Plans (PPHPS) page for more information.
If a person who receives EIDBI services is enrolled in the Special Needs BasicCare program, follow fee-for-service guidelines for service authorizations.
Refer to the EIDBI Benefit Policy manual for definitions.
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