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Elizabeth M. Whitehorn, Director

Provider Notice Issued 02/09/2021

Date:    February 9, 2021

 

To:       All Medical Assistance Program Providers

 

Re:      UPDATE: New Sections Published under the ComprehensiveBilling Guide for Medicaid Managed Care Services

 

 

The Illinois Medicaid Managed CareOrganizations (MCOs), in collaboration with the Illinois Association ofMedicaid Health Plans (IAMHP), have developed a Comprehensive Billing Guide forMedical Assistance Program providers. This billing guide is designed to help providerswho are contracted with the MCOs understand the general MCO billing requirements.

 

MCOs have different policies andprocedures related to billing. With this manual, the MCOs have created a singlesource of information for all claims regardless of provider type.

 

As different sections of theComprehensive Billing Guide are finalized and published, the Department willupdate providers via a provider notice by listing the new sections. Updates andrevisions will be provided quarterly, or more frequently if required. The Guidenow has published information on:

              ·        VisionServices

              ·        PharmacyServices

 

Updated Sections in the Billing Guideinclude:

  • Changes to allowable place of service for encounter rate clinics
  • Updated information on billing quantity limits and pairs for custom orthotic, prosthetic and pedorthic services
  • Addition of guidance for inpatient hospital billing for long-acting reversible contraceptives (LARCs)
  • Change to Molina HealthCare transportation vendor with updated contact information/instructions
  • Change to SUPR (Substance Use Prevention and Recovery) billing guidance – changed “30-day increment” to “monthly increments”
  • Change to claim disposition – overpayments/recoupments – clarification of BlueCross Community Health Plans policy

 

Version 21 of the IAMHP ComprehensiveBilling Guide is posted on the IAMHP website.

 

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

 

 

Robert Mendonsa

Deputy Administrator, Care Coordination​