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Elizabeth M. Whitehorn, Director

Provider Notices issued 05/09/08

New Eligibility Messages

To:​ ​All Participating Medical Assistance Program Providers
​Date: ​May 9, 2008
​Re: New Eligibility Messages​

The purpose of this notice is to inform providers of two new participant eligibility messages being reported on the Medical Electronic Data Interchange (MEDI) Internet site and Recipient Eligibility Verification (REV) system.  These messages are provided in addition to the HFS Medical Program Coverage message.  The eligibility hierarchy displayed is Healthcare and Family Services (HFS) medical programs coverage followed by any special eligibility.  To assist providers in understanding the new messages, the services available for participants who are only enrolled in one or both of the special eligibility are identified below. 

A HFS Social Services - This message identifies temporary eligibility for services that are billable to the HFS.  The covered services are those listed in 59 Ill. Adm. Code 131.50:

  • Community mental health services.

  • Physician psychiatric services.

  • Hospital inpatient psychiatric services.

  • Transportation to and from the above three services.

  • Pharmacy services limited formulary:

http://www.illinois.gov/hfs/MedicalProviders/behavioral/sass/Pages/preferred.aspx

B DHS Social Services - This message identifies enrollment with the Illinois Department of Human Services for one or more of the programs administered by that agency.  Services rendered to individuals with this coverage are billed directly to DHS instead of HFS.  Questions regarding covered services should be directed to Jay Hidalgo at the RIN Help Desk 1-800-385-0872. 

Your participation in our programs is greatly appreciated.  Questions regarding this notice may be directed to the provider hotline at 1-800-226-0768.

Theresa A. Eagleson, Administrator

Division of Medical Programs

 

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