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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/24/08

To: Local Education Agencies

Date: December 24, 2008

Re: Administrative Claim Changes Effective April 1, 2009
 

In an Informational Notice dated October 30, 2008, the department notified local education agencies (LEAs) of the release of a request-for-proposals (RFP) for a statewide vendor to assist in the administration of claiming Medicaid costs incurred by units of local government, including LEAs participating in the School-Based Health Services (SBHS) Program.  The department seeks such a vendor to reduce the administrative burden LEAs bear in completing claims, to reduce the costs LEA’s incur for submitting claims and to assure consistency in reporting.

Once the department secures the services of the statewide vendor, LEAs will no longer be required to have a significant number of staff participate in independent time studies, collect and compile time study results, or independently file administrative claims—either directly with the department or through a third-party entity.

Effective with the administrative claim covering the calendar quarter beginning April 1, 2009, the department will not accept SBHS administrative claims from any source other than the selected statewide vendor. 

For this reason, and although HFS has no authority to direct or proscribe an LEA’s decision to contract independently for services of any kind, we wish to alert LEAs that they may find it unnecessary to contract for any vendor services related to administrative claiming for the calendar quarter beginning April 1, 2009 and beyond. 

The submission of fee for service claims will not be affected by the department's selection of a vendor.  LEAs may continue to submit fee for service claims directly to the department or through a third party vendor. 

Department staff is prohibited from informally discussing this project during the procurement process.  However, questions regarding this notice may be submitted in writing to the Bureau of Program and Reimbursement Analysis, Attn:  RFP Project Contact, at the address in the letterhead above or via e-mail to bpra@illinois.gov. 

Theresa A. Eagleson, Administrator
Division of Medical Programs