Provider Notice issued 08/20/14

Cost Sharing Adjustments

To:​ Participating Physicians, Chiropractors, Podiatrists, Optometrists, Advance Practice Nurses, Federally Qualified Health Center (FQHC), Encounter Rate Clinic (ERC), Rural Health Clinic (RHC), Hospitals and Pharmacies​
​Date: ​August 20, 2014
​Re: Cost Sharing Adjustments​

The purpose of this notice is to inform providers that the department is in the process of issuing adjustments for the following copayment deductions:

  • An adjustment of $1.65 (the difference between a copayment of $3.65 and $2.00) will be processed for All Kids Share participants for whom the department deducted a copayment for an office visit, clinic visit, brand name prescription drug or hospital emergency room visit for dates of service August 30, 2012 through September 27, 2012.

  • An adjustment of $8.00 (the difference between a copayment of $10.00 and $2.00) will be processed for All Kids Share participants for whom the department deducted a copayment for non-emergency use of the emergency room for dates of service August 30, 2012 through September 27, 2012.

  • An adjustment of $3.65 will be processed for All Kids Assist participants for whom the department deducted a copayment for non-emergency use of the emergency room for dates of service July 16, 2012 through March 31, 2013.

The department has systematically identified providers who will receive the adjustments. The copayment adjustments will be tied to the original claim from which the copayment was deducted; which will identify both the participant and the date of service. If you receive a copayment adjustment, and you collected the copayment from the participant, you must refund/balance adjust the amount of the copayment adjustment to the participant. If you did not collect the copayment, no action is required.


The copayment adjustments will be processed over the next several weeks. The following adjustment reason codes will identify the copayment adjustments on the remittance advice: 3535 (institutional-hospital providers), 3223 (non-institutional providers) and 8730 (pharmacy providers).
 
Questions regarding this notice should be directed as follows:
 
Hospitals may contact the Bureau of Hospital and Provider Services, by e-mail at hfs.bchs@illinois.gov or by telephone at 1-877-782-5565.
 
Physician offices, clinics and pharmacies may contact the Bureau of Professional and Ancillary Services by e-mail at HFS.Pharmacy@illinois.gov or by telephone at 1-877-782-5565.
Mashelle Rose, Chief Lisa Arndt, Chief
Bureau of Hospital and Provider Services Bureau of Professional and Ancillary Services