Date: January 26, 2022
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. Versions 23 and 23-A of the IAMHP Comprehensive Billing Manual have been released and posted at https://iamhp.net/providers.
Updates in Version 23 include:
- Pharmacy - Added language regarding 340B Purchased Drugs
- School Based/Linked Health Centers - Added required modifiers for behavioral health service billing
- HCBS Waiver Providers - Corrected information for Box 33B inputs
- Appendix J - Added new appendix: MCO Potentially Preventable Readmission Policies
- Appendix H - Revised BCCHP sample recoupment letter
New Sections Added:
- Professional Services
- Ambulatory Surgical Treatment Centers
- Therapy Providers
- Durable Medical Equipment
Updates in Version 23-A include:
- Updates for Ordering/Referring/Prescribing (ORP) rules for Home Health Care
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.
Deputy Administrator, Care Coordination