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Elizabeth M. Whitehorn, Director

Provider Notice issued 01/12/2024

 

To: Enrolled Physicians; Physician Assistants; and Advanced Practice Registered Nurses
​Date: ​January 12, 2024
​Re: Follow-up to Maternity Codes Rate Increases per Public Act 102-1037 and Bonus Payments for Certain Postpartum Visits Effective January 1, 2023

This notice is a follow-up to the February 21, 2023, provider notice that identified pending maternity code rate increases and bonus payments for postpartum visits meeting specific timelines. These payment changes apply to services for customers covered under the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organizations (MCOs).

The February 21, 2023 provider notice informed enrolled physicians, physician assistants, and advanced practice registered nurses of planned prenatal and postpartum visit and external cephalic version (ECV) rate increases in accordance with Public Act 102-1037. The Department of Healthcare and Family Services (HFS) has also pursued bonus payments for postpartum visits meeting specific timelines.

HFS has received federal approval to reimburse FFS claims at the higher rates and pay the bonus payments. Claims processing updates have been completed for the FFS bonus payments and claims that have been held by HFS have recently been released.

Providers will need to submit FFS replacement claims for any  service dates beginning January 1, 2023, that were billed prior to the February 21, 2023, notification of the delivery date reporting instructions and meet the requirements for a bonus payment.

As a reminder, timely filing for submission of replacement claims is one year from the original paid voucher date. Instructions for completion of a replacement claim may be found in the Chapter 300 Companion Guide for 837P transactions.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS customers or the applicable HCI MCO.

 

Kelly Cunningham, Administrator
Division of Medical Programs