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Provider Notice Issued 05/03/2021

Date:     May 3, 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:

  • School-based Health Centers
  • Birthing Centers
  • Specialized Mental Health Rehabilitation Facilities (SMHRFs)
  • Administrative Days billing guidance added as Appendix I

 

Updated Sections in the Billing Guide include:

  • Skilled Nursing Facilities - Clarification on MLTSS billing for Medicare-covered services
  • Transportation - April 1, 2021 transition of emergency transportation claims to fee-for-service billing to HFS and MLTSS secondary payment guidance
  • Aetna Better Health updates - Revised billing guide to update all IlliniCare information/links to Aetna Better Health information
  • Pharmacy Providers - Addition of Plan Bin/PCN GroupID information

 

Version 22 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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