Provider Notice issued 06/03/13

All Kids Application Agent - Alert May 2013

New Annual Medical Card

During March 2013, all eligible Medical Program clients received a new annual medical card which replaced the monthly card. A sample of the Annual Medical Card can be seen on the HFS Medical Card webpage. A brochure, "Using Your Medical Card" was inserted with these cards. You can view "Using Your Medical Card" brochure on the HFS website. Clients were strongly advised to keep this annual medical card in a safe place, as well as any notices they receive regarding their eligibility.

The annual medical card does not guarantee eligibility for a specific period of time. Medical providers must always verify a person's eligibility prior to providing medical services whether the client is able to present a medical card or not. To check eligibility, clients need to present either:

• The Recipient Identification Number (RIN) for the person needing service, or

• Person's name and date of birth or SSN.

Medical providers should not decline services for clients just because they do not have the medical card with them. Providers can verify eligibility by checking:

1. The Medical Electronic Data Interchange (MEDI) Internet site, or

2. The Recipient Eligibility Verification (REV) system, or

3. calling the provider Automated Voice Response System (AVRS) toll-free number 1-800-842-1461.

After initial implementation, medical cards will be issued only in the following situations:

• a medical case is approved

• a person is added to or deleted from the medical case,

• a REDE or renewal is processed

• a person's name or date of birth is corrected on a medical case, or

• a duplicate card is issued at the client's request.

The annual medical card contains the AVRS toll free number 1-855-828-4995, for clients who wish to verify their own eligibility. Clients will need to enter the 9-digit- RIN of the person for whom they are checking eligibility.

Redetermination Date in MEDI

Providers who have access to the MEDI system may be able to see a patient's redetermination date up to three months in advance at, from the MEDI website. AKAAs can now advise clients that they may be contacted by the state regarding their redetermination and encourage them to act promptly. In order to receive these notices it is crucial that clients make sure the address on file is accurate at all times either by contacting the state or filing a Change of Address form with the U.S. Postal Service.

Illinois Medical Redetermination Project

The Illinois Medicaid Redetermination Project (IMRP) is a new process intended to assist caseworkers with the backlog of cases due for redetermination to make timely and accurate redeterminations for all medical cases on an annual basis, and to increase program integrity.

IMRP will collect electronic information about cases due for redetermination and submit a recommendation to state caseworkers to continue, cancel, or change eligibility. In some situations, clients may be asked to provide necessary documentation to the IMRP. Clients have ten business days to respond. These notices will include the IMRP toll free number, at which clients will have access to bilingual customer support and a variety of resources to confirm their eligibility and comply with the redetermination process.

If the time limit to respond to the notice has elapsed, the control of a case is returned to the DHS office or the All Kids Unit for a final decision. Clients may contact their caseworker if they believe the cancelation is in error due to missing, conflicting, or outdated information.

It is important to note that state caseworkers continue to play an essential role in the redetermination process and have the exclusive responsibility and authority to make the final determination in all cases.

Please encourage participants to pay attention to any deadlines in correspondence and respond accordingly. The hours of operation for the Illinois Medicaid Redetermination Program Hotline or "Call Center" are Monday through Friday, 7:00a.m. - 9:00 p.m. Saturday, 8:00 a.m. - 1:00 p.m. Phone Number: (1-866-255-5437. TTY: 1-877-204-1012. Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992.

2013 Federal Poverty Level

The 2013 Federal Poverty Level (FPL) is being use to determine eligibility for All Kids and FamilyCare. Please view the All Kids Income Standards & Cost Sharing Chart webpage for the new income guidelines. Remember that the income chart is only a guideline for your use. Only staff in the All Kids Unit and the FCRC/DHS local offices can determine eligibility.

Co-pays Update

The Department of Healthcare and Family Services has released an update regarding co-payments for the Family Health Plans. Please view the All Kids Income Standards & Cost Sharing Chart webpage for the new income guidelines.

Prescription Update

The Department of Healthcare and Family Services has released an update to the four prescriptions per month policy. With a few exceptions, prior approval is required for coverage of more than four prescriptions in a month. This new process provides an opportunity to look at a client's total medication list, and, when appropriate, avoid duplication of unnecessary medications. HFS has created an online system to enter prior approvals using the Medical Electronic Data Interchange (MEDI) System or by using the HFS website Four Prescription Policy Override Prior Authorization Request.

Please note that requests faxed to the department prior approval hotline must be data entered after they are received. For that reason, they are likely to take longer to process.

Provider Participation Unit

AKAAs who wish to report changes regarding their site mailing address, contact or telephone information, should submit a request in writing to the HFS Provider Participation Unit (PPU). This will ensure that important correspondence is received in a timely manner. The PPU address and telephone number is:

Healthcare and Family Services

Provider Participation Unit

607 E. Adams

Springfield, IL 62701

Tel: (217) 782-0538

Fax :( 217) 557-8800

Subscription to the HFS website

AKAAs can receive informational notices about the latest developments regarding the medical programs by registering on the HFS Provider Releases and Bulletins E-mail Notification Request webpage and selecting a specific category of interest. Thereafter, any time a new release is posted to the HFS website, AKAAs will receive an electronic notification.

For additional assistance AKAAs should contact their All Kids liaisons.

AKAA Liaison for those located North of I-80

Phone: 1-312-793-5270 Fax: 1-312-793-5278

AKAA Liaison for those located South of I-I80

Phone: 1-217-524-7156 Fax: 1-127-557-4274