Provider Notice issued 10/09/12

Third Party Requests for Medicaid Patient Bills and Medical Records

This notice serves as a reminder that hospitals must inform the department of all third party requests for paid claim information and medical records for patients who receive medical coverage under the department’s Medical Programs.

By law (305 ILCS 5/5-5), the department is requiring that providers of medical services participating in the Medical Assistance Program disclose all inquiries from clients and attorneys regarding medical bills paid by the department, as such inquiries could indicate potential existence of claims or liens for the department.

By administrative rule 89 Illinois Administrative Code Section 140.12(g), the provider shall agree to furnish to the department, in the form and manner requested by it, any information it requests regarding payments for providing goods or services, or in connection with the rendering of goods or services or supplies to recipients by the provider, his agent, employer or employee.

It is the responsibility of the provider to notify the department of any request from attorneys, insurance carriers, or participants for release of participant information or record copy services.

Hospitals should report requests immediately, preferably via fax. The hospital should fax a copy of the request or the subpoena to the department’s Bureau of Collections, Technical Recovery Section. A hospital’s notification can also be telephoned or mailed, as noted below:

• Fax number for Cook County residents: 312-793-8169

• Fax number for all other counties: 217-524-5672

• Telephone number for Cook County residents: 312-793-3529

• Telephone number for all other counties: 217-785-8711

• Mailing address for Cook County residents:

Illinois Department of Healthcare and Family Services

Bureau of Collections, Technical Recovery Section

32 West Randolph Street, 13th Floor

Chicago, Illinois 60601

Attn: Personal Injury Supervisor

• Mailing address for all other counties:

Illinois Department of Healthcare and Family Services

Bureau of Collections, Technical Recovery Section

2200 Churchill Road, Building A-1

Springfield, Illinois 62702-3406

Attn: Personal Injury Supervisor

If a hospital receives a verbal request from a third party, the hospital should be prepared to identify the following to forward to the department:

• The name of the patient and the date of birth

• The recipient identification number (RIN)

• The date(s) of service or date of accident

• The reason given by the entity for requesting the bill

• Any other information, such as the name of the attorney or insurance company

As a reminder, a hospital may not refund a Medicaid payment and assert its own lien on a personal injury settlement. Acceptance of Medicaid is final.

Any questions regarding this notice may be directed to the following:

• Telephone number for Cook County residents: 312-793-3529

• Telephone number for all other counties: 217-785-8711

Theresa A. Eagleson, Administrator

Division of Medical Programs