Frequently Asked Questions

Allowable Costs

Q. Where do I find information on determining allowable costs?

A. OMB Circular A-87, "Cost Principles for State, Local, and Indian Tribal Governments." This circular establishes principles and standards for determining costs for federal awards carried out through grants, cost reimbursement contracts and other agreements with state and local governments and federally-recognized Indian tribal governments.

Also see ASMB C-10: This is the implementation guidance for OMB Circular A-87, containing accompanying Cost Principles and Procedures for Establishing Cost Allocation Plans and Indirect Cost Rates for Agreements with the Federal Government.

Current Procedural Terminology (CPT) Codes

Q. What is the difference between CPT codes and ICD-9 codes?

A. Current Procedural Terminology (CPT) is a listing of descriptive terms and identifying codes for reporting medical services and procedures as they are performed by physicians. The purpose is to provide a uniform language to describe medical, surgical, and diagnostic services. The book is prepared by the American Medical Association.

International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are for the diagnosis, condition, problem, or other reason for the encounter. The ICD-9-CM, diagnosis, is used in conjunction with the CPT procedure book. This book is prepared by Practice Management Information Corporation.

Practice Management Information Corporation
4727 Wilshire Boulevard, Suite 300
Los Angeles, California 90010
1-800-633-7467
Web site: www.medicalbookstore.com

Diagnosis Codes

Q. Is a primary diagnosis code required for fee-for-service claiming?

A. Yes, the primary diagnosis code reflects the condition primarily responsible for the student's treatment. Primary diagnosis codes are listed in the International Classification of Disease, Ninth Edition, Clinical Modification (ICD-9-CM). The ICD-9-CM is revised annually, with code additions, deletions and revisions effective on October 1 of each year. The ICD-9-CM is available from the publisher at:

Practice Management Information Corporation

4727 Wilshire Boulevard, Suite 300

Los Angeles, California 90010

1-800-633-7467

Web site: www.medicalbookstore.com

Electronic Claims Submittal

Q. Which services can be electronically billed?
A. Any services which do not require attachments or accompanying documentation may be billed electronically. Complete information on electronic billing is available in Chapter 100 Handbook, Topic 112.3 and Chapter 300 Handbook for Electronic Processing.

Eligibility (student)

Q. How can an LEA verify a student's eligibility for medical assistance?
A. Eligibility may be verified by any one of the following:
  • Ask to see the student's Medicaid or All Kids eligibility card.
  • Use HFS' Medical Electronic Data Interchange
  • Access HFS' Automated Voice Response System by calling 1-800-842-1461 (toll free). You will need the following information to utilize the system:
    • Your 12-digit provider number;
    • The recipient number for the student you are verifying;
    • The date of service as an 8-digit number (February 15, 2000, would be entered as 02152000).
  • Contact the Department of Human Services office in your community.
Q. Are inquiries requesting verification of students' eligibility for Medicaid kept confidential by HFS?
A. The names of persons receiving public assistance, the names of children with disabilities receiving special education and related services and the names of families/children receiving early intervention services are confidential. Educational records of Medicaid-eligible children with disabilities are protected by the Family Educational Rights and Privacy Act of 1974 and the Illinois School Student Records Act.

Eligibility (practitioner)

Q. How can an LEA verify that a practitioner is not barred from participation in the Medicaid program?
A. Check both the following Web sites:
If you need further information or assistance, contact the Office of the Inspector General at 217-524-3102.

Enrollment Process

Q. What is the process for an LEA to enroll as a provider with School-Based Health Services?
A. Complete information regarding enrollment in School-Based Health Services is available from HFS' Provider Participation Unit (PPU).
Contact the PPU via E-mail; by phone at 217-557-8182, by fax at 217-524-7232, or send a written request to:
Illinois Department of Healthcare and Family Services
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114

Full-Time Equivalency

Q. How do I determine full-time equivalency for the following situation?
My LEA has a regular work week of 37.5 hours. I have a headcount of five clinicians providing speech/language therapy. There are two full-time speech/language pathologists who each work 37.5 hours per week and three part-time speech/language pathologists who each work 15 hours per week.

A. Full-time equivalency is defined as the equivalent number of full-time employees on payroll. It is computed by dividing the total number of hours worked (or used in benefit time) per week divided by the number of hours in a regular work week.

Your LEA has a headcount of five (two full-time employees and three part-time employees). The full-time equivalency for this group of speech/language pathologists is determined by adding the total number of hours worked per week by the speech/language pathologists (37.5 + 37.5 + 15 + 15 + 15 = 120) and then dividing that number by the standard number of work hours per week (37.5).

120 hours/37.5 hours = 3.20 Your LEA has a speech or language pathologist full-time equivalency of 3.20.

Glossary

Q. Is a resource available that defines the terms used in the SBHS program?
A. Both the SBHS Glossary and the SBHS Abbreviations/Acronyms are available from this site.

Handbooks

Q. How do I get a copy of the most recent versions of Chapter 100, Chapter U-200 and the Cost Allocation Plan?
A. The most recent versions of the three publications are available on the HFS Web site.

Indirect Cost Rates

Q. Where can an LEA find their respective indirect cost rate?
A. Approved indirect cost rates are available on the State Board of Education (ISBE) Web site.
Indirect cost rates are calculated annually by ISBE. The indirect cost rate methodology, policy and procedures the State Education Agency (ISBE) uses to establish indirect cost rates for their LEAs is submitted to the Centers for Medicare and Medicaid Services (CMS) for approval and acceptance. Approval and acceptance is confirmed and conveyed to ISBE in a Delegation Agreement for Local Education Agencies.

All Kids Information

Q. I want to distribute information to the students and parents in my school regarding low-cost health insurance. Does the All Kids program provide brochures?
A. Yes. All Kids will provide brochures and application forms to you. In addition, All Kids promotional materials, including posters and fact sheets, are available. All Kids staff are also available to provide training on the program or give a general overview. If you are interested, please contact 1-866-ALL-KIDS or TTY: 1-877-204-1012 for more information or visit the All Kids Web site.

Payment Information

Q. Is there a Web site where LEAs may access payment (warrant) records?
A. Yes, payment information and records are available at the State Comptroller's Web site.
Note: The payment information and records are payee-specific. For example, if an LEA enters its provider number as requested in Step 2 below, but has designated a special education cooperative (or other valid entity) as its Payee 1 (fee-for-service) or Payee 3 (administrative), the system will list no payments or records for the LEA, per se. If the same LEA then enters the cooperative's provider number, the displayed payment information will be the lump sum paid to the cooperative for all relevant LEAs on the inquired date(s).

If an LEA has designated itself as Payee 1 and a cooperative as Payee 3, the displayed information specifically for the LEA will reflect fee-for-service payments only. Administrative payments will be included in payments to the cooperative.

After you access the Comptroller's home page:

  1. Click on "Vendor Payments" near the middle of the top of the home page.
  2. Enter the 9-digit provider number (TIN#) as requested.
  3. Fill in the requested information.
  4. For "Agency" choose "478–Healthcare and Family Services ."
  5. Enter the beginning date of July 1, 2001, or any date after that.
  6. Enter the ending date for whatever month you want to end on.
  7. Under the "Sort Criteria" button, select "Total Warrant Amount."
  8. Select "Find Warrants."

Provider Information Sheet

Q. What is a Provider Information Sheet?
A. When an LEA is approved for participation in the School-Based Health Services program a computer-generated Provider Information Sheet is produced. It will also be generated when there is a change or update to the provider record. The Provider Information Sheet lists the provider name, address, provider number, etc., EXACTLY as the information should appear on submitted claims. The LEA should review the Provider Information Sheet for accuracy when it is received. If the information is correct, the Provider Information Sheet should be filed for reference when submitting future claims. Complete information regarding each entry on the Provider Information Sheet is available in Chapter U-200, Appendix U-3.
Q. What if incorrect or out-dated information is listed on the Provider Information Sheet?
A. To correct or update the LEA name and/or address printed on the provider information sheet, use one of the following options:
 
Option 1: On your current provider information sheet, mark out the incorrect information, enter the correct information in the space below the error, sign the provider information sheet and forward the corrected sheet to the Provider Participation Unit by mail or fax.
 
Option 2: On your LEA letterhead, list the following information:
LEA name and address as it is currently printed on your Provider Information Sheet
Corrected/updated information
Provider number
Effective date of change
Signature
The letter may be mailed or faxed to the Provider Participation Unit:
Illinois Department of Healthcare and Family Services
Provider Participation Unit
P. O. Box 19114
Springfield, IL 62794-9114
or
Fax: 217-557-8182
Questions: Contact the Provider Participation Unit at 217-782-0538 or School-Based Health Services at 217-782-3953.
Q. When information is changed or updated, I receive three identical copies of the revised Provider Information Sheet. Why?
A. The HFS computer system generates a copy of the Provider Information Sheet to be sent to the LEA, the designated Payee 1 address and the designated Payee 3 address. If the LEA address, the designated Payee 1 address and the designated Payee 3 address are the same, all three copies are sent to the same location. The program is not able to consolidate the three mailings when they are all being sent to one address.

Record-keeping Requirements for LEAs (students)

Q. Which student records are required to be kept by the LEA?

A. LEAs must keep a basic record for each student receiving School-Based Health Services. The record must include:

  • Identification of the student (name, address and recipient identification number)

  • Physician order or referral for occupational and/or physical therapy

  • Diagnostic and therapeutic orders

  • Health care provider's notes with an appropriate signature

  • Needs assessment and referrals

  • Consent form, if appropriate

  • Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP). The services provided and the frequency of the services must be documented in the IEP or IFSP

  • Service log, including any required countersignatures of professionals

The record is to include the essential details of the student's health condition and of each service provided.

Q. How long does an LEA need to retain records?
A. Records for fee-for-service claims must be retained for five years. Pending final approval of Illinois' Cost Allocation Plan from the Centers for Medicare and Medicaid Services, administrative claiming records must be retained indefinitely.

Record-Keeping Requirements for LEAs (practitioners)

Q. What type of practitioner credential records does an LEA need to keep on file?
A. The LEA is responsible for maintaining credential records in line with staff qualifications outlined in Chapter U-200 Topic U-210 and applicable law. Records must be stored at the LEA administrative office, and must include applicable licenses and certificates. The LEA must also maintain an up-to-date list of practitioners and associated license numbers.

Remittance Advice

Q. How can an LEA get a duplicate copy of a remittance advice that was never received or that was lost?
A. For duplicate copies of a remittance advice call 1-217-782-7149.
Q. Where can I find information to explain the error codes listed on the remittance advice?
A. Chapter 100, Appendix 8 and Appendix 5, have complete information on the error codes and other information contained in the remittance advice.
Q. Who can I call with questions regarding the remittance advice?
A. Contact the Bureau of Comprehensive Health Services at 217-782-5565.

SBHS

 

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