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Provider Notice Issued 05/14/2020

Date:    May 14, 2020

To:       All Medical Assistance Program Providers

Re:      Update: New and Revised Sections Published under the Comprehensive Billing Guide for Medicaid Managed Care Services





The Illinois Medicaid Managed Care Organizations (MCOs), in collaboration with the Illinois Association of Medicaid Health Plans (IAMHP), have developed a Comprehensive Billing Guide for Medical Assistance Program providers. This billing guide is designed to help providers who are contracted with the MCOs understand the general MCO billing requirements.


MCOs have different policies and procedures related to billing. With this manual, the MCOs have created a single source of information for all claims regardless of provider type.


As different sections of the Comprehensive Billing Guide are finalized and published, the Department will update providers via a provider notice by listing the new sections. Updates and revisions will be provided quarterly, or more frequently if required.


The Guide now has published information on the following topics:

·         Substance use prevention and recovery

·         Dental

·         Psychiatric free-standing hospital

·         Rehabilitation hospital

·         Long term acute care hospital (LTAC)

·         Transportation

·         Ordering, referring, prescribing (ORP) National Provider Identifier (NPI) requirements - Appendix G


Updated Sections in the Billing Guide include:

·         Inpatient hospital - coding guidance and value codes

·         Community-based behavioral services - coding and billing guidance

·         Claim disposition - claim dispute

·         Outpatient hospital – non-APL billing

·         Hospice - patient credit file and value codes

·         Long term care skilled nursing facility – patient credit file

·         Supportive living facility – patient credit file

·         Inpatient hospital (general acute care and children's hospital) - abortion condition code


The Guide is posted on the IAMHP website



For general questions or feedback regarding the Comprehensive Billing Guide, please contact IAMHP. Questions regarding this notice may be directed to the Bureau of Managed Care at 217-524-7478 or the individual HealthChoice Illinois managed care plan.




Robert Mendonsa

Deputy Administrator, Care Coordination