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Provider Notice Issued 01/29/2021

Date:   January 29, 2021                                                   

 

To:      Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP) Providers, Medically Complex for the Developmentally Disabled Facilities (MD/DD) and Specialized Mental Health Rehabilitation Facilities (SMHRF)

 

Re:     Discontinuation of Payment Review Request Form (LTC) HFS 3725 for Dates of Service 12/01/16 and After

______________________________________________________________________________________

 This notice informs long term care (LTC) providers that the Payment Review Request Form (LTC) HFS 3725 should not be completed for claims with dates of service 12/01/16 and after. This form should only be used for dates of service in which the Department initiates the monthly billing via the HFS 3402 LTC Prepayment Report, which applies to dates of service prior to 12/01/16.  

To be considered for additional payment, any disputes regarding payment of a claim for dates of service prior to 12/01/16 rendered after the date of completion of the admission transaction, the Payment Review Request Form must be submitted to the Department within 180 days after the: 

-          date of the remittance advice that initially shows the adjudication for the date(s) of service that are disputed;

-          date of the remittance advice that rejects a previously adjudicated claim, if rejection is the basis for the disputed payment; or

-          date of the remittance advice that adjusts a previously adjudicated claim, if the adjustment is the basis for the disputed payment. 

Questions regarding billing for fee-for-service claims with dates of service 12/01/16 and after should directed to the Bureau of Long Term Care at 1-844-528-8444.

  

Kelly Cunningham, Administrator

Division of Medical Programs​


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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director