Child
Session Date
Time From
Time To
IFSP Service Location
Session Delivered
Service Category
Visit Type
Place of Service
Setting
Participants
Child
Parent/Caregiver
Other Participant
Other Participants
Covisit
Attendance Status
Cancellation Reason
If Missed, Session must be made up by
If Makeup, makeup session for missed session on
ICD-10 Code
CPT Code
2nd CPT Code (optional)
Minutes On This Code
3rd CPT Code (optional)
Minutes On This Code
4th CPT Code (optional)
Minutes On This Code
A session split across codes is billed as one claim with a line per code. Minutes decide each line's units and its share of the visit rate; the first code takes whatever time is left over.
IFSP Functional Outcome(s) and developmental step(s) addressed during this session:
Select a child in Step 1 to load their IFSP goals.
Describe what happened during today's session and the progress made toward the IFSP outcome(s). Include the routine activity and the strategies used in the session. When available, include the parent/caregiver feedback on how they incorporated the strategies between sessions.
Your Raw Notes (AI will expand)
How did you work with the parent/caregiver?
Observed parent/caregiver and child during routines
Parent/caregiver tried activity; feedback exchanged
Demonstrated activity to parent/caregiver
Reviewed communication tool with parent/caregiver
Other Collaboration
Other Collaboration
4. What strategies/activities did you and the parent/caregiver collaboratively agree to do to support their child's learning and development between visits?
Caregiver's Relationship to Child
Review & Edit Note
NYC EI 6/13/2025
Child—
Date of Service—
Time—
CPT Code—
Delivery—
Parent / Caregiver Sign Here
SIGNATURE 1 OF 3
Parent/Caregiver verifies service was delivered on date and time indicated
Provider Sign Here
SIGNATURE 2 OF 3
Provider certifies that services were rendered as documented
Parent / Caregiver — Service Log
SIGNATURE 3 OF 3
Parent/Caregiver acknowledges session was logged in the service record
Session Complete!
Note saved · Service Log updated · Both signatures recorded.
Child—
Date—
StatusFully Documented
Data Recovery
If your children are missing, tap below to find and restore them.
Add New Child
Child's Full Name
Date of Birth
Sex
EI #
Child's Home Address
Street Address
City
State
Zip Code
Authorizations (up to 3)
Authorization 1
Auth #
Service Type
Total Hours
Start Date
End Date
Sessions / Week
Minutes / Session
Pattern
—
Authorization 2 (optional)
Auth #
Service Type
Total Hours
Start Date
End Date
Sessions / Week
Minutes / Session
Pattern
—
Authorization 3 (optional)
Auth #
Service Type
Total Hours
Start Date
End Date
Sessions / Week
Minutes / Session
Pattern
—
Service Type
Approach
Session Duration (min)
ICD-10 Code
CPT Code
IFSP Start Date
Sets when the six-month and annual progress reports fall due.
2nd CPT
3rd CPT
4th CPT
IFSP Functional Outcomes / Goals
No goals yet.
Saved!
Saved Children
No children saved yet.
Provider / Interventionist
Full Name
Credentials
NPI #
License / Cert #
Service Type
Tax ID (SSN or EIN — for 837P billing only)
Billing As
Sets the submitter ID on the file. The guide has agencies send their Tax ID and individual providers their NPI.
Street Address
City
State
ZIP Code
Billing Contact Phone
Profile Saved!
Session Note History
No notes saved yet. Complete a note in the Note tab to see it here.
Attended Sessions
No sessions logged yet. Complete Step 1 and generate a note to log attendance.
Service Log
NYC EI Program Service Log · 7/29/2024 · Parent signs each row after every session.
View Log For Child
Select a child to view their service log. Sessions auto-populate here after each completed note.
Agency Staff
Add therapists and service coordinators once here. Their name, NPI and credentials then fill in automatically on every note they write.
Add Staff Member
First Name
Last Name
Role
NPI #
Discipline / Credential
License #
License Expires
Agency
Tax ID
Street Address
City
State
ZIP Code
Billing Contact Phone
Saved
Staff List
No staff added yet.
Modules
Agencies that use Bloom Note only for note taking can switch billing off. Nothing is deleted — claims, rates and ledger entries stay put and reappear if it is switched back on.
Saved
Records & Backup
Early Intervention records must be kept for six years and be readable without special software. Export regularly and keep the file somewhere safe.
Complete copy of every record, for restoring onto another device.
A page anyone can open in a browser — for an auditor, or the six-year retention file.
Restore
Replaces everything currently in this browser with the contents of a backup file.
Compliance Alerts
Problems found before they reach a claim — lapsed orders, exhausted authorizations, and sessions that would be rejected as duplicates.
0
Blocking
0
Expiring soon
0
To review
Doctor Scripts & Orders
Therapy sessions need a physician order covering the date of service. Sessions without one are flagged before they reach a claim.
Doctor Registry
First Name
Last Name
NPI # *
Medicaid Provider ID
License #
Saved
No doctors added yet.
County / EIO Referring Source
Service coordination and evaluations are not ordered by a physician, but a claim still needs a referring provider. This one is used instead of a doctor for those services.
Referring First Name
Referring Last Name
Referring NPI
Service Facility Name (for sessions outside the child's home)
Required on a claim whenever the place of service is not the home. Sessions at home do not need it.
Saved
Add Script / Order
Child
Ordering Doctor
Discipline
ICD-10 Code
Reference / Notes
Start Date *
End Date *
Saved
Scripts on File
No scripts on file yet.
Early Intervention Service Coordination Note
Contact log for service coordination activity. Bills as T1017 in 15-minute units — separate from therapist session notes.
Child Information
Child
Date of Birth
Date of Service
Service Coordinator
Role
Time & Duration
Start Time
End Time
Enter a start and end time to calculate duration.
1 · Service Coordination Activity Performed
Activity Type
Summary of Activity
2 · Contact Details (if applicable)
Person Contacted
Relationship / Role
Contact Method
Purpose of Contact
3 · IFSP Implementation Connection
4 · Follow-Up / Next Steps
Authorization
Service Coordinator Signature
Saved
Saved SC Notes
No service coordination notes saved yet.
Billing — 837P Generator
Generate an 837P EDI file to upload to EI-Hub. Select a child and date range, review the sessions, then download the file.
Select Child
From Date
To Date
Invoice # (must be unique)
Select a child and date range to preview sessions for billing.
Read a 999 or 277 Response
EI-Hub returns a 999 straight after an upload, saying whether the file was accepted, and a 277 overnight with a verdict on every claim. Paste either one here or choose the file. A 277 also updates Submitted Claims below: each claim is marked accepted or rejected, with the reason and the EI-Hub claim ID a correction needs.
Summary
Work delivered across all children in a date range, and how much of it has been billed.
From
To
Submitted Claims
Every claim this app has generated. Reading a 277 above marks these automatically; the buttons are for anything learned another way. A rejected claim is raised in Alerts until it is resolved.
No claims generated yet.
Claim Modifier Format
Which modifiers each therapy line carries. The EI-Hub guide permits any combination and its examples all use a single modifier, so if a 277 rejects on modifiers, change this and resubmit as a corrected claim.
Saved
Rate Schedule
Amount billed per 15-minute unit. Service coordination pays a different rate from therapy, so each code is priced separately.
CPT / HCPCS Code
Rate Per Unit ($)
Billing Basis
Minutes Per Unit
Modifier (blank for none)
Description
Saved
Bilingual Add-On
Paid on top of the base service. New York pays this by rate code rather than a modifier, so enter the code your billing manual specifies — nothing is assumed.
How Your Program Bills It
Bilingual Code
Add-On Amount ($)
Saved
No rates configured yet.