New Applicants

IMPACT

Providers must enroll in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) before an Early Intervention Credential can be issued. The Bureau of Early Intervention has issued guidelines for IMPACT enrollment. Providers may submit the credential application once they are “In Review” with IMPACT.

IMPACT has slideshows and webinars to explain the process for each type of provider. Please view the appropriate one before you begin the application process.

All Early Intervention Providers MUST associate to the EI Billing Provider 7094782 and the EI MCO 3000005. This is the Early Intervention Managed Care Organization. IMPACT lists it as optional, but it is not optional for Early Intervention Providers.

Click here for the Early Intervention Credential Application

*Writable but needs to be printed and sent to Provider Connections. The application must be mailed. It cannot be emailed or faxed.

For information regarding educational and licensure requirements for specific credentials, please see the Credentialing Overview.

Please complete the application below and follow the corresponding process.

Fingerprint-based background checks are done with livescan technology. This is more reliable than ink fingerprint cards. Very few police departments have been approved by the Illinois State Police for handling fee transactions for livescan. Applicants are not to get fingerprinted until it has been determined by Provider Connections staff that all requirements have been met. An email with the fingerprint form will then be sent. A link to a list of approved vendors is in the email. Several vendors have offices located throughout the state.

Allow 4 weeks for processing the DCFS CANTS (unless there are mitigating circumstances determined by DCFS).

A Note about LLCs:

If you are attempting to enroll as a single-member LLC, please view the memo below. A provider should consult a tax accountant to determine the best situation when setting up a business or even as a self-employed individual. Many providers wish to protect their social security number from the public. This is well understood given the times in which we live. However, Early Intervention providers need to understand the payment procedures mandated within the State of Illinois. These facts pertain only to payments from the State of Illinois/Illinois Office of Comptroller. Again, we request a provider to consult a tax accountant for more specific business/tax guidance.

W-9 Questions regarding LLC-Disregarded Entities

TO LEARN IF YOU ARE ENROLLED TO BILL FOR SERVICES, CALL THE CENTRAL BILLING OFFICE AT (800) 634-8540.

The Department of Human Services, Bureau of Early Intervention requires background checks for all providers applying for or renewing an EI credential. No Provider shall be credentialed to provide early intervention services without the clearance results from all checks being documented by Provider Connections.


All new EI credential applicants are required to document:

      • Specific educational/licensure requirements
      • Completion of EI System Overview Training. System Overview training is now available online and consists of an online component and 1 day face-to-face follow-up training. Provider Connections will process credential applications only if all educational/licensure requirements and documentation of Online System Overview are complete. The credential cannot be issued until Provider Connections receives documentation of the completion of Online System Overview One Day Follow Up Session. Copies of both certificates are required. Register for Online System Overview Training.
        • Online System Overview and Online System Overview Follow-Up must be completed within 3 years of making application for an Illinois Early Intervention Credential. If completed longer than 3 years prior to making application for the credential, individuals will need to repeat both.
        • Service Coordinators and Parent Liaisons will be allowed 3 months from the date their temporary credentials are issued to verify completion of System Overview training and their respective training requirements.
      • Agreement to participate in Ongoing Professional Development Meetings.

Temporary Credential Requirements

New to EI Forum

Individuals new to the early intervention system often have questions to arise. The Early Intervention Training Program offers another level of support: New to EI Forum! On the first Tuesday of each month, from 3-4pm, new providers will have the opportunity to ask questions about our field and our work. EITP team members and partners will be available to answer your questions and provide clarification, guidance and support as you familiarize yourself with the EI program beyond the Systems Overview.