Provider Notice Issued 10/03/2017

​Date:  October 3, 2017

To:  Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Account Managers; and Renal Dialysis Facilities

Re:  Renal Dialysis Add-On Payment Retroactive to Dates of Service Beginning July 1, 2015

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 As a result of Public Act 100-23, Medicaid add-on payments to hospitals and freestanding dialysis facilities previously established under 89 Ill. Admin. Code Section 148.40(g) will be restored retroactively to dates of service beginning July 1, 2015.

The add-on payment is $60.00 per treatment day and is applicable for all of the renal dialysis revenue codes covered by the Department. The add-on payment is not subject to SMART Act (Public Act 097-0689) rate reductions, nor does it apply to Medicare crossover claims or claims for a participant in the State Chronic Renal Disease Program.

The Department will make payments directly to providers for all retrospective payments according to the following:

Fee-For-Service (FFS) Claims

For FFS claims adjudicated prior to the date of reimbursement system modification, the Department will identify the applicable dialysis claims and perform an adjustment to each claim to pay the add-on for all treatment days. Going forward, fee-for-service claims will receive the add-on automatically during adjudication.

MCO Encounter Claims

For services provided to individuals covered by a Medicaid Managed Care Organization (MCO) prior to August 5, 2017, the Department will utilize encounter claim data to reimburse the providers directly via C-13 payment voucher. To assist providers in reconciling their accounts, the Deparment will send a detailed report that matches the C-13 payment amount to individual claims. These reports will be mailed to the provider's payee address on file with the Department, which is the same payee address the Deparment uses to mail paper remittance advices. Providers should contact the appropriate MCO to request submission of any claim that is not identified in the Department's report. 

For services provided on and after August 5, 2017, the reimbursement from the MCOs will refelect the add-on.

Questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 877-782-5565.

Felicia F. Norwood

Director