Agencies
Services
Provider Notice Issued 03/2/2023
- Community Behavioral Services - Correction to Place of Service (POS) 10 to be an on-site POS
- Vision - Update to Blue Cross Community Health Plans (BCCHP) Vision Vendor to Heritage Vision, effective with date of service April 1, 2022
Date: March 22, 2023
To: All Medical Assistance Program Providers
Re: UPDATE: New Sections Published under the Comprehensive Billing Guide for Medicaid Managed Care Services
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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. Versions 26 and 27 of the IAMHP Comprehensive Billing Manual have been released and posted at https://iamhp.net/providers.
Updates in Version 26 include:
Updates in Version 27 include:
· Claim Disposition - Updates to links and addresses for Meridian for Explanation of Payment (EOP) access, corrected claims and dispute submissions
· Long Term Care Services - Clarification added regarding Day of Discharge (non-payable unless due to death) and the addition of billing guidance for member transfers between levels of care within same facility
· Community Behavioral Health Services - Addition of billing guidance for the Pathways to Success program effective January 1, 2023, and updates to Services table to include Integrated Assessment and Treatment Planning (IATP): Licensed Practitioner of the Healing Arts (LPHA) review and changes to Clinical Assessment Tool codes/modifiers effective July 1, 2022
· New Section Added – Diabetes Prevention Program (DPP) and Diabetes Self-Management Education and Support (DSMES) Services
· Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), and Encounter Rate Clinics (ERCs) - Change to Procedure Code T1040 for behavioral health encounters beginning with dates of service on February 1, 2023
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