Agencies
Services
Provider Notice issued 06/26/2023
| Date: | June 26, 2023 |
| To: | Local Education Agencies; School-Based Health Services |
| Re: | School-Based Health Services Timely Filing Change Effective with Dates of Service Beginning July 1, 2023 |
This notice informs Local Education Agencies (LEAs) of a change to the timely filing of student services claims in the School-Based Health Services (SBHS) program.
By provider notice dated May 3, 2023, the Department of Healthcare and Family Services (HFS) informed LEAs of federally-approved changes to expand claiming outside of IEP/IFSP services to Medicaid-enrolled students in the general education population where medical necessity is documented, and a move to a cost-settlement reimbursement methodology. Cost settlement is calculated outside of HFS’ MMIS system. All claiming for the fiscal year must be complete before HFS calculates final settlement amounts. The federal Centers for Medicare & Medicaid Services (CMS) has timely filing requirements for submission of the settlement amounts.
The current timely filing of 18 months from the date of service does not allow HFS adequate time to finalize reports and submit them to CMS; therefore, effective with dates of service beginning July 1, 2023, LEAs will have 180 days from the date of service to submit claims. This aligns LEA claiming with other Medicaid provider timely filing policy.
All provider claims received by HFS are assigned a unique Document Control Number (DCN) which includes the Julian calendar date the claim was received by the Department. HFS must receive a claim, as identified by the DCN date, within 180 days of the date of service.
Questions regarding this notice may be directed to HFS.SBHS@illinois.gov.
Kelly Cunningham, Administrator
Division of Medical Programs