EIDBI Services - Frequently Asked Questions

Ashley M 6 years ago in Industry News/Discussion 0

Hi Everyone!

Procentive has received quite a few questions in regards to EIDBI services, billing DHS, provider registration, and other aspects of this type of care. 

We've had the opportunity to speak directly with Nicole Berning the Autism Policy Lead at Minnesota Department of Human Services (DHS) who was able to answer the most common questions we received. 

Please review the Questions and Answers (Q&A) from Nicole below. If you have any additional questions please contact DHS, submit a ticket to the Procentive Support Desk, or ask other providers on the User Community.

Q: If I have an NPI, why do I need to get an UMPI?

A: Good news - you don't! If you have an NPI you are no longer eligible for an UMPI as the criteria are mutually exclusive (source).

Q: How do I know if I qualify for an NPI or an UMPI?

A: Please review "NPI & DHS: Frequently Asked Questions" (source).

Q: Where do I go to obtain an NPI?

A: Use the National Plan & Provider Enumeration System (NPPES) to enroll for an NPI (source). Help with enrollment is available from NPPES (source).

Q: Don't I have to bill with an UMPI for EIDBI services?

A: All billing to DHS requires a licensed professional to be submitted on the claim, with their registered type 1 NPI, as either the rendering provider or the supervising provider. If you have an NPI you are not required to also obtain and bill with an UMPI.

Q: I'm registered with DHS under my UMPI, can I just use that?

A: As outlined in the Provider Requirements section of the MHCP Provider Manual, any changes in enrollment must be submitted to DHS (source). This includes obtaining a type 1 NPI.

Q: If I can use my UMPI, what is the benefit to obtaining and using an NPI?

A: With DHS, increases in certifications may change your provider level. A lower level provider with an UMPI (e.g. Level 3) may receive less reimbursement for services than a higher level provider with an NPI (e.g. Level 1) (source).

Q: What criteria are used to determine a provider level?

A: The types of providers and their criteria are outlined in EIDBI Provider Overview (source).

Q: I've heard about EIDBI and I think I qualify. Where do I get more information?

A: A great place to start is the EIDBI section of the MHCP Provider Manual (source) or the EIDBI Benefit Policy Manual (source).