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Elizabeth M. Whitehorn, Director

Provider Notice issued 07/07/06

Review and Payment Process for Department of Human Services Funded SASS Inpatient Stays

​To:

​Participating Hospitals, Including Out-of-State Hospitals in Counties Contiguous to Illinois 

 Attention: Chief Executive Officers, Chief Financial Officers and Patient Accounts Managers
​Date: ​July 7, 2006
​Re: ​Review and Payment Process for Department of Human Services Funded SASS Inpatient Stays

The purpose of this notice is to advise hospitals of a clarification to the Department of Human Services (DHS) review/payment process for DHS funded inpatient stays when no application for medical assistance is filed. The policies addressed in this notice apply to out-of-state hospitals only if they are located in counties contiguous to Illinois.

In an informational notice dated March 6, 2006, hospitals were notified that claims received by Healthcare and Family Services (HFS) on or after March 15, 2006, for DHS funded children and adolescents enrolled in SASS would be subject to suspension and denial, if no application for medical assistance was filed. The notice reiterated the hospital’s responsibility to assist the family in filing the application.

The attached table clarifies the review and payment methodology DHS will use for claims received by HFS on or after March 15, 2006. To accommodate the DHS payment methodology, HFS will utilize a manual adjustment procedure when processing payments at the base rate. After these claims are systematically adjudicated at the full rate, HFS will manually adjust the claims DHS has determined to be eligible for reimbursement at the base rate. Hospitals will receive a remittance advice showing the initial full payment of the claim and then another remittance advice will be generated at the time the adjustment is processed. To assist hospitals in identifying these claims, HFS will use a new adjustment Reason Code #4902 “DHS No Application” that will be reported on the remittance advice.

Any questions regarding this notice may be directed to the DHS Children and Adolescent Services unit at 773-794-4875.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs

 

Payment Methodology for DHS Funded SASS Inpatient Stays (pdf)