Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 12/13/02

 

Submittal of Charges to Local Department of Human Services (DHS) Office for Spenddown Calculation

​To: ​Enrolled Hospitals:  Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Renal Dialysis Facilities
​Date: ​December 13, 2002
​Re: ​Submittal of Charges to Local Department of Human Services (DHS) Office for Spenddown Calculation

 

This notice serves to instruct providers in the proper way to submit charges for outpatient series claims, in order for the local DHS office to determine if a patient's spenddown is met.

DPA policy requires that charges for outpatient services be considered by date of service. If a provider submits charges to the local office on a patient's behalf, or gives a billing statement to the patient to submit to the caseworker, the statement must show charges for each date of service. Do not lump charges for multiple days of service into one total sum.

As an example, if a facility submits a series bill with 13 treatment dates in a calendar month, the dates of service must be identified and the charges identified for each date of service on the billing statement. The spenddown will be considered met on the day when the medical charges incurred equal or exceed the patient's spenddown.

Providers who submit charges improperly will have their statements returned by the local office with a request to break down the charges by service date.

Any questions regarding calculation of spenddown should be directed to the local office serving the patient. A listing of DHS local offices with addresses and phone numbers is shown in Chapter 100, General Appendix 1. Chapter 100 is available on the Department's website at <http://www.dpaillinois.com/handbooks/>.