Agencies
Services
Provider Notice issued 01/09/04
Provider Forms Request (HFS 1517) Now Available on the Internet
| To: | Participating Medical Providers |
| Date: | January 9, 2004 |
| Re: | Provider Forms Request (HFS 1517) Now Available on the Internet |
The Department of Healthcare and Family Services supplies required billing forms (with the exception of the UB-92 claim form), prior approval request forms, adjustment forms and various types of pre-addressed mailing envelopes used by the providers to submit claims and adjustments to the department. These materials can only be obtained by submitting Form HFS 1517, Provider Forms Request, to the department.
Form HFS 1517 is now available on the department's Web site. In addition, providers can find the link for Forms Request under Provider information on the Medical Programs page. This form may be completed online and submitted directly to the department. Providers that choose not to submit their request via the Internet may fax in the Provider Forms Request to 217-557-6800 or mail to:
Illinois Department of Healthcare and Family Services
Bureau of Administrative Services
2946 Old Rochester Road
Springfield, Illinois 62703
Providers should refer to Chapter 200 of the applicable provider handbook for the form and envelope numbers appropriate for each provider type. Please limit the quantity of forms and envelopes requested to a three-month supply. Please allow 30 days for delivery of your requested items. Request for items that are out of stock will be placed on backorder status. These requests will be filled the next business day after receipt of the new stock.
Reminder: Single sheet billing forms are intended for use only in laser printers. Multi-page continuous feed forms are intended for use in either typewriters or impact printers.
Questions regarding forms should be directed to the Bureau of Comprehensive Health Services at 217-782-5565.
Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Program