Resources for Contracted Providers

If you are a medical, mental health, lab, or dental provider contracted with the Early Intervention Program, you must comply with the terms of your contract. Here you can find help with understanding your contract, billing expectations and payment details.

Register for the EIP Medical and/or Dental Provider Lists

Sign up to receive important updates and notices regarding the medical and/or dental portion of EIP.

EIP Medical Providers EIP Dental Providers

EIP Provider Contract Information

• Client Services EIP and PrEP DAP Provider Contract (PDF)

• Provider Agreement Appendix A (PDF)

• Provider Agreement Appendix B (PDF)

• Mental Health and Dental Supplement Appendix C (PDF)

Billing Requirements for EIP Providers

Tools for billing and applying your payments for services rendered to EIP clients.

• Benefit Exception Request (Word)
  Request prior authorization for non-covered services and exceptions to rule.

• Dental Covered Services (PDF)

• Dental Waiver (Word)
  Use this form to request that an EIP eligible client's  primary dental coverage be waived to that EIP can act as the client's primary coverage in cases where primary insurance cannot be used.

• EOB Code Definitions (PDF)

• Mental Health Waiver (Word)
  Use this form to request that an EIP eligible client's  primary coverage be waived to that EIP can act as the client's primary coverage in cases where primary insurance cannot be used.

• Medical Schedule of Coverage and Maximum Allowances (PDF)

• Provider Billing and Resource Guide (PDF)
  Guide to billing and policies for EIP Contracted Providers.
   
• Provider Portal Instructions (PDF)
  Detailed instructions on how to access the Provider Portal for contracted Providers. Gives access to payment remittances, eligibility and submitting authorizations.

​Please contact EIP Claims Payments for additional questions.

Get physician's advice or consults on the UCSF Clinician Consultation Center website.