Date: September 16, 2020
To: All Medical Assistance Program Providers
Re: Update: New and Revised Sections Published under the Comprehensive Billing Guide for Medicaid Managed Care Services
The Illinois Medicaid Managed Care Organizations (MCOs), in collaboration with the Illinois Association of Medicaid Health Plans (IAMHP), have developed a Comprehensive Billing Guide for Medical Assistance Program providers. This billing guide is designed to help providers who are contracted with the MCOs understand the general MCO billing requirements.
MCOs have different policies and procedures related to billing. With this manual, the MCOs have created a single source of information for all claims regardless of provider type.
As different sections of the Comprehensive Billing Guide are finalized and published, the Department will update providers via a provider notice by listing the new sections. Updates and revisions will be provided quarterly, or more frequently if required.
The Guide now has published information on:
· Home and Community Based Services (HCBS) Waiver Providers
· Home Health Care (HHC)
· Appendix H - Sample MCO Recoupment Letters
Updated Sections in the Billing Guide include:
· Claim Disposition - Updated process requirements by MCO chart
· Outpatient Hospital – Added one hospital billing scenario; updated the section based on the July 1, 2020 HFS outpatient billing changes
· Claim Distribution - Added overpayment/recoupment subsection
· Substance Abuse Prevention and Recovery (SUPR) Services – Clarified that Medication-Assisted Treatment (MAT) services are a weekly event
· Appendix G - Ordering/Referring/Prescribing (ORP) - Updated ORP guidance for hospitals related to the July 1, 2020 HFS outpatient billing changes
· Transportation Services - Updated language regarding mileage reporting
For general questions or feedback regarding the Comprehensive Billing Guide, please contact IAMHP. Questions regarding this notice may be directed to the Bureau of Managed Care at 217-524-7478 or the individual HealthChoice Illinois managed care plan.
Deputy Administrator, Care Coordination