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Welcome to the Early Intervention Central Billing Office!

BILLING REQUIREMENTS FOR PAPER CLAIM SUBMISSION

In our continued efforts to improve claims processing efficiency and accuracy, and ultimately reducing the time it takes from when providers submit their claims to the receipt of their payment, the Early Intervention Central Billing Office made Qclaims Processing available to providers at no cost.  To begin using SolAce to submit claims for Qclaims processing visit http://spiclaims01.eicbo.info/.

Though there is simply no comparison between the benefits of the accelerated time to payment provided by Qclaims over paper claim submission, we’re streamlining paper claims processing as well.  In doing so, there are some enhanced requirements for submitting paper claims that must be employed to improve the way these claims are handled.  Those include:

  • All paper claims must be typewritten.  Given the differences in handwriting and other factors impacting legibility, we can no longer accept handwritten claims.

*DO NOT handwrite a signature in Box 31.  The name must be typewritten.

  • Paper claims should be submitted on the UB04, DHS Transportation Billing form, or the following versions of the CMS 1500:

    • Red line forms—these are the “original” forms, not photo copies
    • No line forms—these are available on a variety of websites, including eicbo.info by typing the claim information into SolAce and choosing the no-line print option.

 *Please note: black line forms, or photo copies of the original form, can result in delays in processing your claims and/or claims being denied due to an inability to accurately read the information on the form.

  • Typed information must be completely within the boxes on the claim form.  Information typed directly on the lines will cause errors in processing your claims and could result in claims being denied due to an inability to accurately read the information on the form.

Please refer to the items below for an “At a Glance” reminder of important paper billing requirements and refer to the BILLING INFORMATION FOR PROVIDERS document for a complete listing of billing requirements.

Required Billing Information and Detail on Submission

Child’s Name

Billed amount
  1. Last name, First name—Alpha characters ONLY
  2. CMS 1500 form – box 2
  3. UB04 billing form – box 8
  1. Numeric
  2. CMS 1500 form – box 24F
  3. UB04 billing form – box 47

 

Child’s EI number

Total billed amount

  1. 6 digit numeric ONLY (DO NOT include “EI #” in the box)
  2. CMS 1500 form – box 1A
  3. UB04 billing form – box 60
  1. Numeric
  2. CMS 1500 form – box 28
  3. UB04 billing form – box 47

Child’s current address

Enrolled provider who performed service

  1. Alpha/numeric
  2. CMS 1500 form – box 5
  3. UB04 billing form – box 9
  1. Last name , first name—Alpha ONLY
  2. CMS 1500 form – box 31
  3. UB04 billing form – box 80

Diagnosis code

Associate provider’s name (if applicable)
  1. 3-5 digit—Numbers ONLY
  2. CMS 1500 form – box 21
  3. UB04 billing form – box 66
  1. Last name, first name—Alpha ONLY
  2. CMS 1500 form – box 19
  3. UB04 billing form – box 80

Date of service

Provider tax ID/SS#

  1. mm dd yy format ONLY—Numbers ONLY
  2. CMS 1500 form – box 24A
  3. UB04 billing form – box 45
  1. Numeric—NO DASHES
  2. CMS 1500 form – box 25
  3. UB04 billing form – box 5

 

Place of service

Provider billing address

  1. 2 digit Numeric code
  2. CMS 1500 form – box 24B
  3. UB04 billing form – box 57
  1. Alpha/numeric
  2. CMS 1500 form – box 33
  3. UB04 billing form – box 1

CPT/HCPCS procedure code

Patient account number (optional)

  1. 5 digit Numeric/alpha-numeric code
  2. CMS 1500 form – box 24D
  3. UB04 billing form – box 44
  1. Alpha/numeric
  2. CMS 1500 form – box 26
  3. UB04 billing form – box 3

Modifier (when required)

Interpretation services
  1. Alpha code
  2. CMS 1500 form – box 24D
  3. UB04 billing form – box 44
  1. digit description of service interpreted (such as PT, ST, etc.)—Alpha code
  2. CMS 1500 form – box 23
  3. UB04 billing form – box 80

Units—NOT MINUTES (15 minutes = 1 unit)

NPI Number
  1. Numeric 
  2. CMS 1500 form – box 24G
  3. UB04 billing form – box 46
  1. Numeric 
  2. CMS 1500 form – box 24J
  3. UB04 billing form – box 56