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Elizabeth M. Whitehorn, Director

Provider Notice issued 09/09/02

Illinois Guide for School-Based Health Services Administrative Claiming

​To: ​Local Education Agencies
​Date: ​September 9, 2002
​Re: ​Illinois Guide for School-Based Health Services Administrative Claiming

 

The document guiding LEAs in the proper submission of administration claims, previously titled the Cost Allocation Plan (CAP), is now titled the Illinois Guide for SBHS Administrative Claiming, which will be referred to as the Illinois Guide. The Illinois Guide becomes effective the October – December, 2002 claiming quarter. The Illinois Guide is available for downloading on the DPA website: 

 


https://www.illinois.gov/hfs/MedicalPrograms/sbhs/Pages/default.aspx

 

New Requirement

 

Required for processing the claims for FY03 is the completion of the CEO information on the "contacts" screen. The LEA chief executive or chief financial officer's name, address, phone, fax and e-mail must be entered on the appropriate screen or the quarterly claim for the respective LEA claim will not be processed. This requirement is effective beginning the October – December, 2002 quarter. E-mail and compact disk (CD) versions of the computer program will be distributed before December 15, 2002 to ensure a timely claim submission in January 2003.

Do visit our Web site noted above. If you have any questions about this notice, or any information on the Web site, please call or e-mail. My staff is here to assist you and your staff with the school-based health services program.

 

IDPA School-Based Health Services

 

Administrative Claiming Activity Codes Guide

 

  1. Determine the general category of the activity
    Outreach Activity
    Case Management
    General Administration
    Fee-for-Service Activity
    Daily School (educational) Activity
  2. Find the matching category code in the table below and determine which activity description most closely matches the activity performed.
Outreach Activity Codes Outreach Activities
Code A1 Disseminating Medicaid/KidCare program information to the general school population
Code A3 Disseminating non-Medicaid/KidCare program information to the general school population
Code B1 Assisting with Medicaid/KidCare program eligibility determination process
Code B3 Assisting with non-Medicaid/KidCare program eligibility determination process
Code C Disseminating Medicaid/KidCare program information to the medically at-risk school population
Code C2 - SPMP ONLY SPMP providing information to the medically at-risk school population. Medical expertise must be required and utilized
Code C3 Disseminating non-Medicaid/KidCare program information to the medically at-risk school population
Code D1 Program planning, policy development, and interagency coordination staff use this code when collaborating with other agencies to increase the number or capacity of Medicaid/KidCare providers
Code D3 Participating in collaborative efforts with non-Medicaid/KidCare related agencies

The information in this table is a general guide for coding activities in an administrative claiming time study. When determining which code is appropriate, review Exhibit II in the Illinois School-Based Health Services Administrative Claiming Guide for detailed activity code examples.

Case Management Activity Codes
Case Management Activities
Code E1 Referring, coordinating, or monitoring Medicaid/KidCare services that are not related to an IEP
Code E2 - SPMP ONLY SPMP referring, coordinating, monitoring delivery of Medicaid/KidCare services. Medical expertise must be required and utilized
Code E3 Performing case management activities for non-Medicaid/KidCare services
Code F1 Referring, coordinating, or monitoring Medicaid/KidCare services that are related to an IEP
Code F2 - SPMP ONLY SPMP referring, coordinating, or monitoring Medicaid/KidCare services that are related to an IEP. Medical expertise must be required and utilized
General Administration Activity Code General Administration Activities
Code G1 Performing routine management duties
Fee-for-Service Activity Code Fee-for-Service Activities
Code H3 Providing medical care or treatment to a student
Daily School Activities Activity Code Daily School Activities
Code I3 Conducting school-related activities that are not health-related