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Provider Notice Issued 02/09/2021

Date:    February 9, 2021

 

To:       All Medical Assistance Program Providers

 

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 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. Updates and revisions will be provided quarterly, or more frequently if required. The Guide now has published information on:

              ·         Vision Services

              ·         Pharmacy Services

 

Updated Sections in the Billing Guide include:

  • Changes to allowable place of service for encounter rate clinics
  • Updated information on billing quantity limits and pairs for custom orthotic, prosthetic and pedorthic services
  • Addition of guidance for inpatient hospital billing for long-acting reversible contraceptives (LARCs)
  • Change to Molina HealthCare transportation vendor with updated contact information/instructions
  • Change to SUPR (Substance Use Prevention and Recovery) billing guidance – changed “30-day increment” to “monthly increments”
  • Change to claim disposition – overpayments/recoupments – clarification of BlueCross Community Health Plans policy

 

Version 21 of the IAMHP Comprehensive Billing Guide is posted on the IAMHP website.

 

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.

 

 

Robert Mendonsa

Deputy Administrator, Care Coordination​


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JB Pritzker, Governor • Theresa Eagleson, Director