Provider Notice issued 11/21/2025

UPDATE: Revisions to the Comprehensive Billing Guide for Medicaid Managed Care Services- Version 35.0

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 HealthChoice Illinois 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 revisions. Version 35.0 of the IAMHP Comprehensive Billing Manual has been released and posted here.   

Updates in Version 35.0 include:

• General Claim Submission Guidelines-Type of Claim Submission
  Updated links and addresses for Aetna Better Health and Blue Cross Community Health Plan

• Claim Disposition- Corrected Claims
  Updated links and addresses for Aetna Better Health and Blue Cross Community Health Plan

• HCBS Waiver Providers- Claim Submission Requirements
  Updated Coding Requirements table/code changes 

• Appendix F
  Updated instructions to Form 1977 (see Note under Part IV instructions)

• SUPR- Professional Services
  Clarification added regarding Rendering Providers
  

  Telehealth guidance added

• SMHRF Providers- Coding Requirements
  

  Language added regarding billing of LOA days

• Genetic Counselors
  COS changed from 100 to 144

• FQHC, RHC, and ERC Providers- Submission Guidelines
  Added Meridian to list of plans requiring inclusion of Rendering Provider NPI on claim

• SUPR Providers- New Section Added
  Guidance regarding billing SBIRT services

• Pharmacy Providers- HIV/Contraceptive Services
  Link added for HIV services Standing Order

• Community Behavioral Services- Pathways to Success
  Clarified CCSO monthly billing span (26 days)
  Removed reference to OBRA codes vis a vis member authorization

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.

Helena Lefkow
Deputy Administrator, Care Coordination