Date: September 23, 2020
To: Participating Physicians and Physician Assistants
Re: Chapter A-200, Handbook for Practitioners Rendering Medical Services Update and Handbook Supplement Update - Claim Submission Policy for Services Rendered by Physician Assistants Effective with Dates of Service on and after July 1, 2020
This bulletin provides new HFS billing instruction for services rendered by physician assistants (PAs). Although PAs have been allowed to enroll previously with the Department due to their affiliations with the Department’s HealthChoice Illinois managed care organizations (MCOs), changes to the Physician Assistant Practice Act require new billing instructions for PA services submitted to HFS for participants under Medicaid fee-for-service. For HealthChoice Illinois MCO-enrolled members, providers must submit claims for services directly to the appropriate MCO and adhere to the MCO’s claim submission guidelines.
The Physician Assistant Practice Act clarifies that all services rendered by a PA must be billed by the PA’s employer utilizing the name and National Provider Identifier (NPI) of the PA as the rendering provider. Effective with dates of service beginning July 1, 2020, the PA, and not the collaborating physician, must be identified as the rendering provider. The rendering PA’s employer must be identified as the billing provider and will receive reimbursement for the service from HFS. This does not change the established patient care protocols in place between PAs and their collaborating physicians.
In order for the Department to adjudicate a claim for a PA’s services, the PA must be enrolled as a Rendering/Servicing provider in IMPACT. Rendering/Servicing PAs not already enrolled should follow the steps on the IMPACT webpage.
HFS Billing Instructions:
Claims for PAs may be billed on the 837P, Direct Data Entry (DDE) through MEDI, or on paper claim forms HFS 2360 Health Insurance Claim Form and HFS 3797 Medicare Crossover Invoice. Paper forms should only be submitted if an attachment is required for processing of the claim.
Limitations to Services for Physician Assistants
Charges may not be submitted for group psychiatric services or telepsychiatry at the distant site
PAs are directed to the following resources:
Handbook Supplement for full paper claim completion requirements for the HFS 2360 and HFS 3797 – Medicare Crossover Invoice.
Questions regarding fee-for-service claims may be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565. Questions regarding claims for managed care participants should be directed to the specific MCO.
Interim Medicaid Administrator