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Everything You Need to Know About Adilchild Therapy

Common Questions and Answers

A proven approach to help children with autism and related conditions develop essential skills, reduce behaviors, and gain independence.

An evidence-based program providing early, individualized support for children with autism and related conditions, focusing on development and behavior.

No, ABA (Applied Behavior Analysis) therapy is not the same as EIDBI (Early Intensive Developmental and Behavioral Intervention) therapy, although ABA is one of the treatment approaches used within the EIDBI framework. EIDBI is a broader program in Minnesota that includes ABA as well as other evidence-based interventions, such as developmental and relationship-based therapies, to support individuals with autism spectrum disorder (ASD) and related conditions. The EIDBI program focuses on a comprehensive, multi-disciplinary approach tailored to each child’s needs.

A person is eligible if they meet all of the following criteria:
•Have autism spectrum disorder (ASD) or a related condition
•Have completed a comprehensive multi-disciplinary evaluation (CMDE) that confirms their medical need for EIDBI services
•Are enrolled in Medical Assistance (MA), MinnesotaCare, TEFRA, or other qualifying health care programs
•Are under the age of 21
The EIDBI benefit covers a range of services, including:
•Comprehensive multi-disciplinary evaluation (CMDE)
•Individual treatment plan (ITP) development and progress monitoring
•Coordinated care conference
•Intervention services (individual, group, and higher intensity)
•Intervention observation and direction
•Family or caregiver training and counseling
•Telehealth services
•Travel time for providers
When a transition or discharge occurs, the Qualified Supervising Professional (QSP) should download and complete the EIDBI Transition and/or Discharge Summary (DHS-7109A) electronically. While this form is optional, it is recommended for documentation purposes.
 
To complete the process:
•Review the How to Complete ITP and Progress Monitoring (DHS-7109) EIDBI Benefit Policy Manual for guidance.
•Submit DHS-7109A to the medical review agent or the person’s corresponding health plan.
•For changes to an existing service agreement, upload the form to the approved case and adjust the units to reflect the requested modifications.
•The medical review agent has 20 business days from the receipt of the form to review and process the requested changes.

No, EIDBI providers are not required to bill a member’s commercial insurance before billing the Medicaid plan for services. Since EIDBI services fall under Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, they can be billed directly to Medicaid. However, third-party liability reporting is still required if the EIDBI agency receives payment from a source other than the Department of Human Services (DHS).

When submitting claims for EIDBI services, you should follow these guidelines:
•Bill only for services already provided: Only submit claims for EIDBI services that have been rendered.
•Bill only for services approved on the Service Agreement (SA): Ensure that you are billing only for services that are authorized on the SA.
•Separate services by SA requirements: Do not include on the same claim services that require an SA together with those that do not.
•Submit usual and customary charges: Use your standard charges for the services provided.
•Use current and specific diagnosis codes: Always use the most up-to-date and precise diagnosis codes.
•Itemize daily services: Bill each day separately on the claim.
•Appropriate place of service: Use Place of Service (POS) 12 (home and community) for EIDBI services provided in a community setting as specified in the person’s Individual Treatment Plan.
Ensure that all documentation of the services provided are complete and accurate before submission.
•Duration of Service Authorization: Each EIDBI service authorization request cannot exceed a 180-day time span.
•Annual CMDE Submission: Complete and submit the person’s annual Comprehensive Multi-Disciplinary Evaluation (CMDE) at least 30 days, but no more than 60 calendar days, before the end date of the current service authorization period.
•ITP and CMDE Signing: The Individual Treatment Plan (ITP) and CMDE may be signed on the same day; however, the ITP must not be signed before the CMDE is completed.
•Retroactive Approval: Acentra Health may retroactively approve up to 180 days for services that require authorization, provided that the qualified providers and the legal representative sign the ITP and CMDE before any of these services are delivered.

The purpose of the EIDBI benefit is to provide medically necessary, early, and intensive intervention for individuals with autism spectrum disorder (ASD) and related conditions. Additionally, it is designed to educate, train, and support parents and families; promote the individual’s independence and participation in family, school, and community life; and ultimately improve long-term outcomes and quality of life for both the individuals and their families.

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At AdilChild, we’re here to help every child grow and thrive. Our personalized programs focus on teaching practical skills, promoting independence, supporting emotional well-being, and encouraging creativity. Join us at AdilChild and let’s help your child reach their full potential and thank you.

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  • 1990 Burns Ave Apt 107, St Paul MN, 55115
  • (612) 481-6172
  • Support@adilchild.com
  • (612) 481-6172

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