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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/28/12

Corrected Post Office Box for Mailing Adjustment Form HFS 2249

To:​ Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; Renal Dialysis Facilities; and Ambulatory Surgical Treatment Centers (ASTCs)​
​Date: ​December 28, 2012
​Re: Corrected Post Office Box for Mailing Adjustment Form HFS 2249​

The department has changed the P.O. Box to which institutional providers must submit paper adjustment forms.

For all hospitals, renal dialysis facilities, and ambulatory surgical treatment centers (ASTCs), adjustment forms should be sent to the address below:

Illinois Department of Healthcare and Family Services

P.O. Box 19101

Springfield, Illinois 62794-9101

The department does supply a pre-addressed mailing envelope, the HFS 1416 envelope, which providers may use to submit their adjustment forms. These envelopes may be ordered from the Forms Request page of the department's Web site.

Please ask billing staff to begin using the new address immediately. Any questions regarding this notice may be directed to a UB-04 billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs