Agencies
Services
Provider Notice Issued 10/05/2018
Date: October 5, 2018
To: All Medical Assistance Program Providers
Re: Improper Submission of the CMS 1500, Health Insurance Claim Form
This notice is a reminder that if providers choose to bill paper claim forms, only HFS proprietary paper claim forms are to be submitted for billing Medicaid non-institutional services or supplies. This applies to claims for participants who are covered under fee-for-service Medicaid and are not enrolled in a HealthChoice Illinois managed care plan. Providers should refer to the applicable plan for managed care billing guidelines.
The Department cannot process the CMS 1500 claim form. Due to the volume of CMS 1500 forms that the Department receives, staff is unable to return them to providers. Providers will not be able to determine a claim status for a service submitted on a CMS 1500.
HFS strongly encourages providers to bill the Department electronically using the Medical Electronic Data Interchange Internet Electronic Claims (MEDI IEC) System. However, if providers must submit paper forms, the attachment to this notice identifies the appropriate paper forms to be used by non-institutional providers when billing for services rendered and/or equipment supplied to HFS participants. Paper claim forms may be ordered from the Department’s website.
More specific billing guidance is contained in Provider Handbooks that are located on the Department’s website. The appendices contain billing and mailing instructions for the specific HFS proprietary paper claim form to be used by the provider.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Teresa T. Hursey
Medicaid Director
|
Form Number |
Form Title |
Provider Type or Service |
|
HFS 215 |
Drug Invoice |
Pharmacy
|
|
HFS 1443 |
Provider Invoice |
Audiology Chiropractic Community Mental Health Centers billing SASS services Local Education Agencies Optical Supplies Physical/Occupational/Speech Therapies Podiatry |
|
HFS 2209 |
Transportation Invoice |
Transportation |
|
HFS 2210 |
Medical Equipment/Supplies Invoice |
Audiology (hearing aids and supplies) Durable Medical Equipment and Supplies |
|
HFS 2211 |
Laboratory/Portable X-ray Invoice |
Lab and X-ray services |
|
HFS 2212 |
Health Agency Invoice |
Home Health services |
|
HFS 2360 |
Health Insurance Claim Form |
Advanced Practice Nurses Dentists (for covered medical services not billable under the Dental Program) Federally Qualified Health Centers/Rural Health Centers/Encounter Rate Clinics Imaging Centers Independent Diagnostic Testing Facilities Licensed Clinical Social Workers Licensed Clinical Psychologists Local Health Departments Optometrists Outpatient Hospitals services (designated in the Handbook for Practitioner Services) Physicians School- Based Clinics |
|
HFS 3797 |
Medicare Crossover Invoice |
All non-institutional services after Medicare adjudication |