Agencies
Services
Provider Notice issued 10/07/11
- Physicians
- APNs
- Podiatrists
- Therapists
- Dentists
- Audiologists
To: |
Participating Hospitals; Physicians; Advanced Practice Nurses; Podiatrists; Occupational, Physical, and Speech Therapists; Dentists; and Audiologists |
Date: |
October 7, 2011 |
Re: |
Change in Billing for Illinois Department of Corrections (IDOC) and Illinois Department of Juvenile Justice (IDJJ) Inmates |
This notice outlines HFS' billing process for providers treating inmates of the IDOC and IDJJ. Recent updates to those agencies' contracts with their medical vendor have prompted changes to the services billed directly to HFS.
Effective with dates of service on and after May 16, 2011, any of the following practitioners who submit claims for professional services rendered in the hospital inpatient, outpatient, and emergency room settings must submit inmates' claims directly to HFS under the practitioner's name and NPI:
Hospitals that bill fee-for-service for any of the services listed under Topic A-203.13 of the Handbook for Practitioner Services must also submit their fee-for-service claims to HFS.
A claim from one of the above practitioners for services performed in the hospital inpatient, outpatient, or emergency room setting must contain an applicable Place of Service code as identified in the Handbook for Practitioner Services, Appendix A-10.
Providers are reminded that, effective June 15, 2011, hospital-owned offsite clinics within a 35-mile radius of the main hospital are considered part of the hospital for outpatient billing purposes. For dates of service on and after June 15, 2011, practitioners billing HFS for fee-for-service claims associated with a hospital Ambulatory Procedures Listing (APL) procedure should utilize Place of Service Code 22 – Outpatient Hospital.
Practitioners who provide office services at the off-site clinic must bill under their name and NPI with Place of Service Code 11 - Office to the medical vendor. These services will not be paid by HFS.
Services billed to HFS that are not performed in the inpatient, outpatient, or emergency room setting will be denied with Error Code H05 – Service Not Covered-Recip IDOC/IDJJ. Any service not performed in these settings must be billed to the IDOC or IDJJ medical vendor for adjudication. Providers may contact HFS at 217-782-3541 for IDOC/IDJJ medical vendor information.
There are no changes to hospital institutional (UB-04 or 837I) billing. These claims continue to be submitted to HFS.
Any other questions may be directed to a billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs