Billing Webinar

Illinois Department of Healthcare and Family Services

Federally Qualified Health Centers (FQHC)
Rural Health Centers (RHC)
Encounter Rate Clinics (ERC)

September 24, 2014

What’s New at HFS

New links on the HFS Medical Programs website.  Please refer to the September 19, 2014 Provider Notice for details.

  • Claims Processing System Issues will provide you with the most current system issues the Department is experiencing, as well as information regarding resolutions.

**Providers are encouraged to review this site for possible explanation to their billing questions or issues before contacting a billing consultant**

  • Non-Institutional Providers Resources is designed to assist Non-Institutional Providers with HFS billing and payment for services, as well as provide answers to frequently asked questions and links to webinar slides.

Non-Institutional Providers Resources Page

Public Act 0651 Medicaid Benefit Changes

Tobacco Cessation Counseling Services

Duration of Counseling

Pharmacotherapy

Update in Adult Dental Program Services

Four Prescription Policy

Affordable Care Act (ACA) Increased Payment for Primary Care Services

Services eligible for the ACA increased payments:

Adjustments with Reason Code 3314

Adjustments with Reason Code 3317

  • Informational message "ACA Pmt Recoup/Client Category Ineligible" – adjustments will correct payments to providers for Title 21 (state-funded) participant eligibility categories for which increased payments did not apply; Adjustments to recoup these payments have been completed per the April 14, 2014 notice  

Reminder: Annual Medical Cards

Home Health Care Services

Face-To-Face Requirement

Rate Change

180 Day Time Limit for Claim Submittal

Co-Pays/Cost Sharing

Co-Pays/Cost Sharing for IHW

Services and co-payment amounts for participants enrolled in the Illinois Health Women program, effective with dates of service on or after July 16, 2012 include:

Group Psychotherapy

Therapy Services

*Please be aware any SMART Act or Public Act 0651 changes supersede information in the handbook, which is undergoing revision*

Definition of an Encounter

An encounter is defined as a face-to-face visit with one of the following:

Billable Place of Service for Encounters

Encounter Clinic Billing

Detail codes billed should include all services provided so long as they are provided as part of a billable encounter, such as:

Behavioral Health Encounter Codes

**COS indicates Category of Service. The COS for which a clinic is enrolled for behavioral health services can be found on the provider information sheet.

EPSDT Detail Codes

**Please note revisions to the Healthy Kids Handbook are pending and a new Healthy Kids handbook will be announced via provider notice and posted to the website soon**

Additional information may be found in the Healthy Kids Handbook (HK-200) & Appendices

Adult Preventive Services

BMI Assessment & Obesity-Related Weight Management Follow-Up for Children & Adolescents

Prenatal/Perinatal Services

Newborn Eligibility

Newborn Care

IHW/Family Planning

Reimbursement Changes for Long-Acting Contraceptives

Long-Acting Contraceptives and Transcervical Sterilization Devices

Billing for Long-Acting Contraceptives and Transcervical Sterilization Devices

Billing guidelines:

Non-Prescription Emergency Contraception

Procedure Code S5190

Practitioner Fee Schedule

HIPAA 5010

837P HIPAA 5010

When billing:

Billing Format

Billing Loop 2010AA – Segment 85

Rendering Provider Loop 2310B – Segment 82

Billing Format

Billing Loop 2010AA – Segment 85

Rendering Loop 2310B – Segment 82

  • enter the rendering provider's name, individual NPI, and taxonomy

Service Line

ICD - 10

Third Party Liability

Medical Electronic Data Interchange (MEDI)

Once the Illinois Digital Identity registration is complete, login to: www.myhfs.illinois.gov

For technical assistance with the following please contact 217-524-3814:

For technical assistance with the following please contact 1-800-366-8768, option 1, option 3:

Voids & Replacement Claims

COMMON BILLING ERRORS

HFS remittance advice error codes are detailed in Appendix 5 of the Chapter 100 Handbook for Providers of Medical Services, General Policy and Procedures

Contact Numbers for Billing Questions or Prior Approval

Main Number : 877-782-5565

**Please Note: Claim status will not be offered by phone. Claim status is available using MEDI, the 835 ERA, and the paper remittance advice.

HFS Medical Website http://www.illinois.gov/hfs


Non-Institutional Providers

 

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