Provider Notice issued 08/04/16

Illinois Medicaid Program Advanced Cloud Technology (IMPACT) Hospital Specialty/Subspecialty Selection

The purpose of this notice is to remind hospital providers when completing an initial application or revalidation in the IMPACT system to select only Specialty/Subspecialty combinations that mirror their Provider Information Sheet Categories of Service. Failure to select and include all Specialty/Subspecialty combinations billed by the provider could result in delay and/or rejection of claims.

The Department will update your enrollment information in the legacy system known as MMIS with all the Specialties/Subspecialties from the IMPACT provider enrollment system. This data exchange updates Legacy MMIS files from the completed and approved IMPACT enrollment data. If anything is omitted or incorrect on a provider’s IMPACT application, it will update the Legacy system incorrectly. Claims submitted with information that is different from the most recent Provider Information Sheet may delay processing or be rejected. The Provider Information Sheets are mailed upon enrollment approval in IMPACT and when data updates to the MMIS system are completed. Providers are responsible to review the information for accuracy.

Example: Psychiatric Care

If a hospital bills Psychiatric Care under a separate National Provider Identifier (NPI) and a new Legacy Provider Number is generated with the separate IMPACT enrollment, the provider will receive a Provider Information Sheet with the “new” Legacy Provider Number. If patients are still receiving care under the original Legacy Provider Number, hospitals will need to:

·         Retain the original Legacy Provider number with eQHealth Solutions, Inc., the Department’s Quality Improvement Organization (QIO).

·         Add Specialty/Subspecialty: General Acute Care/Inpatient Psychiatric Distinct Part Unit (and Outpatient Psychiatric if applicable) to the original Legacy Provider Number’s IMPACT enrollment until all of the affected patients are discharged.

·         Provide the new Legacy Provider Number to eQHealth when a new Provider Information Sheet is received.

Changes to provider information must be electronically submitted by the provider through the IMPACT provider enrollment as a “Modification” and are not effective until approved by HFS staff and updated to the Legacy MMIS system.

When making modifications to correct a Specialty/Subspecialty, hospitals will not be able to back-date the Specialty/Subspecialty Begin Date to coincide with the Legacy Category of Service (COS) Begin Date. Please document the Begin Date on the Checklist section within the specific enrollment. The IMPACT Help Desk staff can assist in correcting the date.

When selecting a Specialty other than General Acute Care and specific Subspecialties as noted, please use the following guidelines:

·         Hospitals must have Specialty 003 (General Hospital - Children Section) in Legacy enrollment to enroll with a Children’s (Inpatient or Outpatient Section) Subspecialty in IMPACT.

·         Hospitals must have Specialty 004 (Children's Hospital) in Legacy enrollment to enroll with Children’s Specialty in IMPACT.

·         Hospitals must have Specialty 007 (Long Term Acute Care Hospital) in Legacy enrollment to enroll with an LTAC Specialty in IMPACT.

·         Rehabilitation Care/Outpatient Rehabilitation Therapy may be selected even if you are a General Care Hospital (Legacy Provider Type 30).

·         Hospitals must be a Psychiatric Care or Provider Type 31 in Legacy MMIS to enroll with Psychiatric Care Specialty in IMPACT.

·         Hospitals must be a Rehabilitation Care or Provider Type 32 in Legacy MMIS to enroll with Rehabilitation Care Specialty in IMPACT, with the exception to Outpatient Rehabilitation Therapy noted above.

·         Psychiatric (Legacy Provider Type 31) or Rehabilitation (Legacy Provider Type 32) Hospitals are able to select Subspecialty: Outpatient Psychiatric (Legacy COS 27/28) or Outpatient Rehabilitation Care (Legacy COS 29) in IMPACT under General Acute Care Specialty as applicable.

Additional information on the IMPACT system plus frequently asked questions, webinars and other training guides are available at the IMPACT website.  

If you have additional questions or need assistance, please contact the IMPACT Help Desk:

• By email: IMPACT.HELP@Illinois.gov
• By phone: (877) 782-5565, select option #1.