How do I refer to Early Intervention?
Use the Standardized Illinois Early Intervention Referral Form. Full completion of the form provides the EI team with information helpful to determine appropriate evaluations and services for the child. Send the form by FAX to the appropriate Early Intervention Child and Family Connections office (CFC) based on the child’s zip code. If faxing is impossible, you or the parent may call the CFC directly. The local CFC can be located through the DHS Office Locator.
Early Intervention Central Billing Office Billing Information for Providers
Billing Information Release Form (5/14) – CQuest is commited to protecting the privacy of the Protected Health Information (PHI) and complying with HIPAA Privacy Rules and Regulations. In doing so the Billing Information Release Form must be completed by the provider prior to releasing or disclosing of any PHI BIR Instructions.
Transportation Billing Form (06/13) -This is the transportation services billing form for Early Intervention. Instructions
Electronic Billing– Qclaims is the Early Intervention Central Billing Office’s method of allowing EI providers to submit claims electronically to the Central Billing Office. This software is free, easy to use and completely HIPAA compliant. Additionally, it drastically cuts the time from claim submission to provider payment, creates a permanent record of your billing and submission dates, and reduces your cost of doing business in EI. To get started simply visit http://spiclaims01.eicbo.info/ and view the initial sign up documentation.
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