Provider Notice Issued 02/08/2021

Date:   February 8, 2021

 

To:       Enrolled Physicians, Physician Assistants, Advance Practice Nurses, Local Health Departments, Federally Qualified Health Centers, Rural Health Centers, Encounter Rate Clinics, Hospitals, and Independent Laboratories

 

Re:      Lab Testing and Claims Submittal Related to COVID-19 – Launch of HFS COVID Portal

 

 

This notice provides updated information to that communicated in the July 17, 2020 and September 25, 2020 provider notices regarding the Department’s deployment of an online portal for reimbursement of COVID-19 testing services for uninsured individuals who have been tested for COVID-19. Claims for participants enrolled in a HealthChoice Illinois health plan should be billed to the appropriate managed care plan.

 

The Department is pleased to announce the launch of the HFS COVID Portal, which is now ready to accept claims beginning with dates of service March 18, 2020. The portal is designed to receive and process claims for uninsured individuals, regardless of income, citizenship, or immigration status. Providers are reminded to first check MEDI for active Medicaid coverage and MCO enrollment before requesting a RIN and submitting claims through the HFS COVID portal. Tests for customers who already have Medicaid coverage should be billed through regular channels. Testing and testing-related covered procedure codes are identified in the COVID-19 Fee Schedule.  

 

For the uninsured population, providers should continue to use the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program  to request reimbursement for the following services, regardless of income, citizenship, or immigration status:

            ·         COVID-19 testing and testing-related services for dates of service between February 4 and March 17, 2020

            ·         Treatment services for dates of service after March 17, 2020, as treatment is not covered under the HFS COVID-19 Testing Program

             ·         COVID-19 vaccine administration

 

In the HFS COVID Portal, the Department will accept patient information contained within an Excel file layout. This online portal has the functionality to:

·         Create a RIN only - Providers who want to generate their own claims can request the Department generate a Recipient Identification Number (RIN) only for the uninsured COVID-19 testing patients. Files containing RINs for patients uploaded through the portal will be available for download by the provider after the RINs are assigned. Uninsured individuals who have RINs created through the portal will not receive a Medical Card.

·         Create both a RIN and Claim - The full functionality of the portal will generate RINs and claims. 

·         Create a claim if a current RIN is found - If a RIN exists and the participant is eligible for traditional Medicaid without MCO enrollment, a claim will be generated. If the participant is eligible through a Medicaid managed care plan, the claim will reject, and providers must bill the plan. 


 

Some duplicate RINs may be created through the HFS COVID Portal if providers submit patient information for individuals who already have a Medicaid RIN with HFS. Providers should first check MEDI for active Medicaid coverage and MCO enrollment before requesting a RIN and submitting claims through the HFS COVID portal. MEDI will display “COVID TESTING COVERAGE” for the new RINs created through the portal that have coverage limited to COVID testing and testing related services. Providers should continue to submit claims for other services through the regular full coverage Medicaid RIN.

 

Federally Qualified Health Centers (FQHCs) may bill specimen collection procedure code 99000 – Handling of Specimen for Transfer from Office to Lab, as fee-for-service utilizing the full functionality of the portal. However, if an FQHC needs to bill a T1015 encounter for a testing-related service, it can only use the portal to obtain a RIN. The FQHC will have to submit the encounter claim through its normal billing process outside the portal once a RIN is obtained. 

 

The portal functionality allows the Department to generate non-institutional claims for hospitals, even if the date of service is on or after July 1, 2020, when hospitals transitioned to all-institutional billing.  Please note, these are the only non-institutional claims the system will process using a hospital’s NPI.  A hospital may not submit a non-institutional claim outside the portal.

 

As a reminder, providers must be enrolled with the Department to be reimbursed, and a public domain Illinois.GOV e-mail address will be required to login to the portal. Providers must create an account at the Illinois.GOV website. More detailed registration instructions are available on the homepage of the HFS COVID Portal.

 

The following documents are linked below:

·         Detailed file requirements

·         A sample Excel file layout

 

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565. 

 

 

 

Kelly Cunningham, Administrator

Division of Medical Programs

 

 

 

 · COVID Portal Provider Upload File Layouts (pdf)

 · COVID Testing Submission File Layout Sample (xlsx)​​

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