HFSIMPACTGlossary

Glossary

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​Application ID A system generated number which a provider must use to locate their enrollment during revalidation or track their application in the system.​
Association​ An action taken by a provider to "associate" themselves to another entity.​
Atypical Agency Provider (AA)​ A facility, agency, or organization that is not required to obtain an NPI (National Provider Identifier) in order to enroll in the IMPACT system.​
Atypical Individual Provider (AI)​ ​A Sole Proprietor or Rendering/Servicing provider who is not required to obtain an NPI (National Provider Identifier) in order to enroll in the IMPACT system
Atypical Provider​ A provider who is delivering services to Medicaid clients that are not considered to be health care services.  These providers are not required to obtain an NPI (National Provider Identifier).  The Centers for Medicare and Medicaid Services (CMS) defines Atypical Providers as providers that do not provide health care. This is further defined under HIPAA in Federal regulations at 45 CFR 160.103. Taxi services, home and vehicle modifications, and respite services are examples of Atypical Providers reimbursed by the Medicaid program. Even if these Atypical Providers submit HIPAA transactions, they still do not meet the HIPAA definition of health care and should not receive an NPI number. ​
Billing Agent​ A business authorized to submit Medicaid HIPAA compliant transactions; an entity who exchanges Electronic Protected Health Information (ePHI) on behalf of Medicaid Providers or other authorized parties. They may also be referred to as a Clearinghouse, Software Vendor, or Value Added Network (VAN) depending on their relationship to the health care provider.​
Billing Provider​ A provider who submits claims and/or receives payments for an Individual Rendering/Servicing or Sole Proprietor provider. The Billing Provider must be approved in IMPACT prior to the submission of a new enrollment application for an individual Rendering/Servicing provider.​
Clearinghouse​ A Clearinghouse is the business authorized to submit Medicaid HIPAA compliant transactions; an entity who exchanges Electronic Protected Health Information (ePHI) on behalf of Medicaid Providers or other authorized parties. They may also be referred to as a Billing Agent, Software Vendor, or Value Added Network (VAN) depending on their relationship to the health care provider.​
Comptroller​ The state agency which certifies the validity of a TIN (Tax Identification Number) as reported by the provider.  All TINs must be certified by the Comptroller prior to enrollment into IMPACT.​
​Denied Application An application denied by the Office of Inspector General based on Sanctions, Criminal Background checks or other identified problems.​
​Disassociation An action taken by a provider to "disassociate" themselves from another entity.​
Enrollment Checklist​ A list of questions which the provider is required to answer as they work through their enrollment into IMPACT.  Actions may be required based on the answers given.​
Enrollment Review Questions​ Questions which State staff will use to determine the actions to be taken on a specific provider application.​
Facility, Agency, Organization (FAO)​ An entity that provides health care services. An FAO includes Hospitals, Nursing Facilities, Laboratories, etc., and has a Type 2 NPI (National Provider Identifier) number associated to them. Licensing is required for this type of entity.  ​
​Go-Live The date the system will become accessible.​
Group​ An organization of individual providers that provides medical or dental services.  A Group provider will require a Type 2 NPI. No licensing is required for this type of organization.​
Healthcare Provider ​ A provider of services as defined in section 1861(u) of the Act, 42 U.S.C. 1395X(u), a provider of medical or health services as defined in section 1861(s) of the Act, 42 U.S.C. 1395x(s), and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business.​
​HFS Provider Number A number assigned to a provider in the Legacy System.​
​IMPACT ​Illinois Medicaid Program Advanced Cloud Technology. IMPACT is a multi-agency effort to replace Illinois’ 30-year-old  Medicaid Management Information System (MMIS) with a web-based system that meets federal requirements, is more convenient for providers and increases efficiency by automating and expediting state agency processes.
​Indicator Enrollment codes set by state review staff in IMPACT which reflects specific business status or service type(s).   ​
Individual Rendering/Servicing Provider​ ​A provider who orders, prescribes or refers items or services through a Group, Facility, Agency, Organization (FAO) or an Individual/Sole Proprietor.  A Rendering/Servicing provider does not bill directly to Medicaid.
​Initial Enrollment ​The action of a person or entity who is applying to actively participate in the Illinois Medical Assistance Program who has not previously been enrolled.
​Legacy MMIS The existing HFS Medical Management Information System (MMIS) which is a computer system that will remain in use to process claims until full implementation into the IMPACT cloud environment. ​
​Managed Care Organization (MCO) A health care delivery system consisting of affiliated hospitals, physicians and others which provide a wide range of coordinated health services; MCO is an umbrella term for health plans that provide health care in return for a predetermined monthly fee and coordinate care through a defined network of physicians and hospitals (e.g HMO, POS, PPOs). An MCO is an HMO or HMO-like health plan that has its own network of doctors and hospitals. Clients that enroll in an MCO get all of their services from the doctors and hospitals that are in the MCO network unless they get approval from the MCO.​
National Provider Identifier (NPI) Number ​ A unique ten-digit identification number issued by the Centers for Medicare and Medicaid Services (CMS) and required by the Health Insurance Portability and Accountability Act (HIPAA) for health care providers in the United Sates. Providers must use their NPI to identify themselves in all HIPAA related transactions.

NPI Type 1
Health care providers who are individuals, including physicians, dentists, and
all sole proprietors. An individual is eligible for only one NPI.

NPI Type 2
Health care providers who are organizations, including physician groups, hospitals, nursing homes, and the corporation formed when an individual incorporates him/herself.
​Rendering/Servicing Provider ​An individual provider who will be rendering services to Medicaid clients but will not be submitting claims directly to the state for reimbursement.
​Revalidation ​The process when a person or entity currently enrolled in the Illinois Medical Assistance Program verifies and updates their enrollment information on file.
​Service Location ​The location(s) where services are rendered.  ​The location(s) where services are rendered.  For Transportation Providers, the Service Location is the location(s) where its commercial patient transport vehicles are garaged, when the garage location is other than the county location of the primary office.
​Software Vendor ​A Software Vendor is the business authorized to submit Medicaid HIPAA compliant transactions; an entity who exchanges Electronic Protected Health Information (ePHI) on behalf of Medicaid Providers or other authorized parties. They may also be referred to as a Billing Agent, Clearinghouse, or Value Added Network (VAN) depending on their relationship to the health care provider.
​Sole proprietor ​A provider that owns his/her own practice.   A Sole Proprietor may receive payments directly or associate to Billing Providers and/or Billing Agents.
​State (Sister) Agencies ​A core group of State of Illinois agencies and program areas involved in and affected by the IMPACT system.
Tax Identification Number (TIN) ​Tax number registered with the Office of the Comptroller, which may be either a Social Security Number (SSN) or a Federal Tax Identification Number (FEIN). This number is used for tax purposes in the United States and may be assigned by the Social Security Administration or by the Internal Revenue Service (IRS).
Taxonomy Code(pdf) ​An alphanumeric 10 character code selected by the health care provider based upon their education, license/certification and the services being rendered. This code is used in billing HIPPA related transactions and is required when applying for a National Provider Identifier Number. The code is structured into 3 distinct levels including Provider Type, Classification and Area of specification.
 

 

 

 


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