Provider Notice issued 08/24/12

Reimbursement Changes to the Illinois Hemophilia Program

To: Participating Medical Assistance Providers​
​Date: ​August 24, 2012
​Re: Reimbursement Changes to the Illinois Hemophilia Program​

As a result of Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, effective September 1, 2012, the Department of Healthcare and Family Services (HFS) will reimburse services provided to participants in the Illinois Hemophilia Program at the department’s standard reimbursement rates. As a result, claims received on or after September 1, 2012, will no longer be reimbursed at the provider’s billed charges.

The Illinois Hemophilia Program will continue to reimburse for two comprehensive hematology visits per fiscal year for each enrolled participant, as well as for covered factor and related medications. Due to the cancelation of the federal waiver program, the Illinois Hemophilia program will no longer be offering additional coverage for primary care physician visits to qualifying participants.

Claims must be received by the department within 180 days from the date of service to be eligible for payment. The program remains the payer of last resort and all insurance must be billed as primary. Non-cooperation of a patient with billing their primary insurance carrier may render the patient ineligible for claim reimbursement under the Illinois Hemophilia Program.

Questions regarding this notice may be directed to:

Attn: Program Coordinator

Illinois Hemophilia Program

Healthcare and Family services

P.O. Box 19129

Springfield, Illinois 62794-9129

Telephone: 217-782-3303

E-Mail the HFS Webmaster

Theresa A. Eagleson, Administrator

Division of Medical Programs