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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/09/2024

 

To: All Medical Assistance Program Providers
​Date: ​February 9, 2024
​Re: UPDATE: New Sections Published under the Comprehensive Billing Guide for Medicaid Managed Care Services

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 may 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. Version 30 of the IAMHP Comprehensive Billing Manual has been released and posted at https://www.iamhp.org/providers.

Updates in Version 30 include:

  • Updates to links/contacts/addresses for Meridian and Molina health plans
  • Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) and Encounter Rate Clinics (ERCs) – updates about provider registration and claim form elements and additional guidance regarding maternity billing
  • Inpatient Services – updates to interim claims and additional guidance on billing for different categories of service
  • Professional Services – additional guidance regarding global maternity billing
  • Appendix L – updated guidance regarding maternity billing and the addition of plan-specific guidance when TPL coverage is terminated.

 

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.

 

 

Laura Ray
Interim Deputy Administrator, Care Coordination