Provider Notice issued 10/14/08

To: Enrolled Hospitals:  Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers

Date: October 14, 2008

Re: Clarification of Hospital Fee-for-Service Billing for Illinois Department of Corrections (IDOC) and Illinois Department of Juvenile Justice (IDJJ) Inmates

This notice informs hospitals of a clarification regarding billing of professional services rendered to inmates of the IDOC and IDJJ.

In a notice dated January 11, 2008, the department informed hospitals of policy and billing changes regarding salaried medical staff and their professional services in the hospital outpatient setting.  Hospitals were informed that, effective with service dates on and after July 1, 2008, hospitals would no longer be able to bill for the professional services of salaried physicians and APNs under the hospital fee-for-service National Provider Identifier (NPI).  The department will require these fee-for-service claims to be billed under the name and NPI of the practitioner who renders the service.  This notice is available on the department’s Web site at

                                        <http://www.hfs.illinois.gov/hospitals/>.

EXCEPTION:  Claims for services provided by salaried physicians and APNs for IDOC and IDJJ patients are excluded from this requirement.  For this patient population, all outpatient services provided by salaried physicians and APNs must be billed to HFS, using the hospital’s name and fee-for-service NPI.  Claims submitted to HFS under a physician or APN name and NPI for services provided to IDOC and IDJJ inmates will be rejected. 

For additional information regarding billing for IDOC and IDJJ inmates, please refer to an August 15, 2007, notice at the Web site shown above. 

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator 

Division of Medical Programs