Provider Notice issued 08/15/07

Claims for Illinois Department of Corrections (IDOC) and Illinois Department of Juvenile Justice (IDJJ) Inmates

The purpose of this notice is to provide hospitals with information on the correct billing procedures for services provided to IDOC and IDJJ inmates. 

Inpatient Admission and Outpatient Services Rendered Through 04/30/07

The following categories of service rendered to IDOC/IDJJ inmates through April 30, 2007 should be billed directly to HFS: general inpatient hospital services (Category of Service 20), inpatient physical rehabilitation hospital services (Category of Service 22), general outpatient services (Category of Service 24) and physical rehabilitation clinic services (Category of Service 29). The services must be billed to HFS on the UB-92 paper form or in the 837I electronic format. Other hospital claims submitted to HFS for an IDOC/IDJJ inmate that contain services other than those identified above will reject with the error message "A82 – Service Is Not Payable by HFS." These services must be billed to IDOC's/IDJJ's medical vendor.

All fee-for-service claims, including claims for salaried physician services associated with an APL procedure, must be billed directly to the medical vendor. Fee-for-service claims for IDOC/IDJJ inmates billed to HFS will also reject with the error message "A82 – Service Is Not Payable by HFS." 

Inpatient Admission and Outpatient Service Dates Beginning 05/01/07

Effective with dates of service on or after May 1, 2007, all services provided by an enrolled hospital provider, including those reimbursed as fee-for-service, must be billed directly to HFS. This applies to services billed to HFS on the 2360 and 1443 paper forms or in the 837P electronic format, and includes lab services, radiology services, therapies, and other professional services. 

Eligibility Verification

All current and future inmates will be assigned a case number. Inmates who qualify for Medicaid will be assigned the applicable Category of Assistance. Inmates who do not qualify for Medicaid will be given a special eligibility segment designating them as having "Department of Corrections Eligibility." Responsible Office Number 195 within the case identification number will designate the patient as an IDOC or IDJJ inmate. The responsible Office Number appears as the second set of numeric digits in the case identification number.

When an inmate presents at a hospital for services, an IDOC/IDJJ representative must accompany the inmate. The representative may give the hospital the recipient identification number for the inmate, if one has already been assigned, for the hospital to use when billing HFS. IDOC/IDJJ inmates are not issued regular medical cards and providers should not complete an application for medical assistance for IDOC/IDJJ inmates.

The message, "Eligible for Limited IDOC Hospital Benefit Package," now appears in the Medicaid Recipient Eligibility Verification (REV) System; the Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System; and the Automated Voice Response System (AVRS). After checking eligibility through one of the verification systems listed above, hospitals may submit their bills.

In the event that the above message does not appear for an inmate, a hardcopy claim must be filled out in accordance with department billing standards and mailed to HFS. The recipient identification number can be omitted from the claim. Hospitals with questions regarding these types of bills may call HFS at 217-785-0710 for assistance.

The "Eligible for Limited IDOC Hospital Benefit Package" message only extends medical coverage to inmates who are in custody of IDOC/IDJJ at the time services are rendered. The IDOC/IDJJ special eligibility segment is considered valid only if an IDOC/IDJJ representative accompanies the person to the hospital. In the event that an IDOC/IDJJ representative does not accompany an inmate but the above message appears in the eligibility verification system, hospital providers are to consider the person as private-pay or self-pay and can complete an application for assistance on their behalf.

Paroled or discharged inmates whose eligibility has not been updated are not the responsibility of HFS.

Claims received for IDOC/IDJJ inmates will be placed in a pending file and paid on a fixed schedule once a month by HFS. Rejected claims will report on weekly rejected vouchers along with the hospital's other claims.

Providers wishing to receive e-mail notification, when new provider information has been posted by the department, may register at the following HFS Web site: http://www.hfs.illinois.gov/provrel

Electronic claim submission via the Internet is available by registering on the department's Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System at: <http://www.myhfs.illinois.gov/>. The MEDI/IEC System is available to enrolled providers and their authorized staff, claim submitting agents and payees. During the registration process, you will be given access to specific claim formats based upon your enrollment status with the department.

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs