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 domains of people with ASD and related conditions. As well as:
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:
Refer to the Overview of EIDBI Providers page in the EIDBI Benefit Policy manual for more information. Refer to the MHCP Provider Manual-Provider Basics for general MHCP provider requirements.
To enroll as an EIDBI provider with MHCP, follow the instructions on the Early Intensive Developmental Behavioral Intervention (EIDBI) Provider Enrollment page. All MHCP providers must register a MN–ITS account.
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 prior to service delivery:
The following services do not require authorization prior to service delivery:
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. Before requesting an authorization for the first time, contact KEPRO to let them know you are a new provider and give them your NPI number.
Note the following timelines in the EIDBI service authorization process:
The CMDE provider is responsible to:
In general, the EIDBI provider agency is responsible to:
KEPRO will do the following within five business days of receiving the CMDE:
KEPRO will do the following within ten business days of receiving the ITP:
If KEPRO pends the case in the Atrezzo portal and requests additional information:
DHS will send letter notifications to the provider:
The provider may request:
Technical Change Request
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.
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 authorization requests after the service is provided. Submitting a request for additional authorization of services does not guarantee an approval or MHCP payment.
Contact the KEPRO provider call center at 866-433-3658 or 612-354-5589 for the following:
Refer to the KEPRO website and the MHCP Provider manual Authorization section for more information.
For instructions on how to complete the ITP and CMDE forms, see the EIDBI Policy Manual-CMDE page and ITP page. A MN-ITS log in username and password is required to access the forms. If a provider requires a username and password, see the MHCP Provider Manual MN-ITS User Manual and then select Create/Modify MN-ITS User Access from the table of contents.
Refer to the MHCP Provider Manual-Billing Policy Overview section for general MHCP billing requirements.
Refer to the EIDBI Billing Grid for:
Refer to the MHCP Fee Schedule for the most current rate information.
To submit claims for EIDBI services:
Note: As of Jan. 1, 2018, all claims submitted for any services delivered by a Level III provider are required to have the UMPI number of the rendering provider.
When submitting claims for EIDBI services:
Note: MHCP will not accept claims for CMDE services rendered by a CMDE clinical trainee at this time. MHCP accepts application forms for enrollment as the CMDE supervisor. Refer to the EIDBI Provider Enrollment page for more information. MHCP will update providers after systems have been programmed and claims are being accepted.
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 EIDBI telemedicine section of the EIDBI Provider Enrollment page 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.