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Elizabeth M. Whitehorn, Director

Provider Notice Issued 05/09/2025

    

To: All Medical Assistance Program Providers
​Date May 9, 2025
​Re:
 UPDATE: New Sections Published under the Comprehensive Billing Manual 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 Manual for Medical Assistance Program providers. This billing manual 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. This manual creates a single source of information for all MCO claims regardless of provider type.

As different sections of the Comprehensive Billing Manual are finalized and published, the Department will update providers via a provider notice by listing the new sections. Version 34 of the IAMHP Comprehensive Billing Manual has been released and posted at https://www.iamhp.org/providers.

Updates in Version 34 include:

·         Community Based Behavioral Services Coding and Billing Guidelines - Moved IATP: LPHA Review from Group A service to Group B service.
·         HBIA/HBIS Populations - Added note regarding termination of HBIA Program.
·         Pharmacy Providers - Guidance added regarding HIV and Hormonal Contraceptive Assessment and Consultation Services.
·         New Section Added - Doulas and Lactation Consultants.
·         New Section Added - Certified Community Behavioral Health Clinics.
·         Professional Services Family Planning, Pregnancy/Maternity Care Services - Clarification added re billing for multiple births - Corrected prenatal billing guidance for subsequent visits.
·         COB/TPL - Clarification added regarding billing for multiple births.
·         Genetic Counseling Services IMPACT Registration - Added Legacy PT and COS to Enrollment Table.
·         Provider types billing 837P - Correction to requirements for Optometrists and Podiatrists providing services in LTC settings (Place of Service 31, 32, 33).
·         Pediatric Services Coding Requirements - Removed note that BCBS does not allow billing for well and sick child visit on the same day (i.e., BCBS does allow this).
·         Diabetes Prevention Program (DPP) and Diabetes Self-Management and Education (DSMES) Services - Addition of POS 10 and modifier 93 for telehealth services.
·         Genetic Counseling Services Coding Guidance Allowable Billing Codes - Replacement of Procedure Code 96040 with 96041.

 

For general questions or feedback regarding the Comprehensive Billing Manual, 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.

 

 

Helena Lefkow
Deputy Administrator, Care Coordination