Provider Notice Issued 02/08/2021
Date: February 8, 2021
To: Enrolled Physicians, PhysicianAssistants, Advance Practice Nurses, Local Health Departments, FederallyQualified Health Centers, Rural Health Centers, Encounter Rate Clinics, Hospitals,and Independent Laboratories
Re: Lab Testing and Claims Submittal Relatedto COVID-19 – Launch of HFS COVID Portal
Thisnotice provides updated information to that communicated in the July 17, 2020 and September 25, 2020 provider notices regarding theDepartment’s deployment of an online portal for reimbursement of COVID-19 testingservices for uninsured individuals who have been tested for COVID-19. Claimsfor participants enrolled in a HealthChoice Illinois health plan should bebilled to the appropriate managed care plan.
The Departmentis pleased to announce the launch of the HFS COVID Portal,which is now ready to accept claims beginning with dates of service March 18,2020. The portal is designed to receive and process claims for uninsuredindividuals, regardless of income, citizenship, or immigration status. Providers are reminded to first check MEDIfor active Medicaid coverage and MCO enrollment before requesting a RIN and submittingclaims through the HFS COVID portal. Tests for customers who already have Medicaid coverageshould be billed through regular channels. Testing and testing-related coveredprocedure codes are identified in the COVID-19 Fee Schedule.
Forthe uninsured population,providers should continue to use the Health Resources and Services Administration (HRSA)COVID-19 Uninsured Program to request reimbursement for the followingservices, regardless of income, citizenship, or immigration status:
· COVID-19testing and testing-related services for dates of service between February 4and March 17, 2020
· Treatmentservices for dates of service after March 17, 2020, as treatment is not coveredunder the HFS COVID-19 Testing Program
· COVID-19vaccine administration
In theHFS COVID Portal, the Department will accept patient information containedwithin an Excel file layout. This online portal has the functionality to:
· Createa RIN only - Providerswho want to generate their own claims can request the Department generate aRecipient Identification Number (RIN)only for the uninsured COVID-19 testing patients. Files containing RINs forpatients uploaded through the portal will be available for download by theprovider after the RINs are assigned. Uninsured individuals who have RINscreated through the portal will not receive a Medical Card.
· Create both a RIN and Claim - The full functionality of theportal will generate RINs and claims.
· Create a claim if a current RIN is found- If a RIN exists andthe participant is eligible for traditional Medicaid without MCO enrollment, aclaim will be generated. If theparticipant is eligible through a Medicaid managed care plan, the claim will reject,and providers must bill the plan.
Someduplicate RINs may be created through the HFS COVID Portal if providers submitpatient information for individuals who already have a Medicaid RIN with HFS. Providersshould first check MEDI for active Medicaid coverage and MCO enrollment beforerequesting a RIN and submitting claims through the HFS COVID portal. MEDI willdisplay “COVID TESTING COVERAGE” for the new RINs created through the portalthat have coverage limited to COVID testing and testing related services.Providers should continue to submit claims for other services through theregular full coverage Medicaid RIN.
FederallyQualified Health Centers (FQHCs) may bill specimen collection procedure code 99000– Handling of Specimen for Transfer from Office to Lab, as fee-for-service utilizingthe full functionality of the portal. However, if an FQHC needs to bill a T1015encounter for a testing-related service, it can only use the portal toobtain a RIN. The FQHC will have to submit the encounter claim through itsnormal billing process outside the portal once a RIN is obtained.
Theportal functionality allows the Department to generate non-institutional claimsfor hospitals, even if the date of service is on or after July 1, 2020, whenhospitals transitioned to all-institutional billing. Please note, these are the only non-institutionalclaims the system will process using a hospital’s NPI. A hospital may not submit a non-institutionalclaim outside the portal.
As areminder, providers must be enrolled with the Department to be reimbursed, anda public domain Illinois.GOV e-mailaddress will be required to login to the portal. Providers must create anaccount at the Illinois.GOV website. More detailed registrationinstructions are available on the homepage of the HFS COVID Portal.
Thefollowing documents are linked below:
· Detailedfile requirements
· Asample Excel file layout
Questionsregarding this notice may be directed to the Bureau of Professional andAncillary Services at 877-782-5565.
Divisionof Medical Programs