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Elizabeth M. Whitehorn, Director

Provider Notice Issued 05/03/2021

Date:     May 3, 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:

  • School-based Health Centers
  • Birthing Centers
  • Specialized Mental Health Rehabilitation Facilities (SMHRFs)
  • Administrative Days billing guidance added as Appendix I

 

Updated Sections in the Billing Guideinclude:

  • Skilled Nursing Facilities - Clarification on MLTSS billing for Medicare-covered services
  • Transportation - April 1, 2021 transition of emergency transportation claims to fee-for-service billing to HFS and MLTSS secondary payment guidance
  • Aetna Better Health updates - Revised billing guide to update all IlliniCare information/links to Aetna Better Health information
  • Pharmacy Providers - Addition of Plan Bin/PCN GroupID information

 

Version 22 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​