Date: September 22, 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. Version 25 of the IAMHP Comprehensive Billing Manual has been released and posted at https://iamhp.net/providers.
Updates in Version 25 include:
- FQHCs, RHCs and Encounter Rate Clinics - Addition of Modifier 93 when delivering telehealth services via Audio Only and Place of Service code 10 when Originating Site is the Patient's Home.
- Community Behavioral Services - Addition of Modifier 93 and POS code 10 when delivering telehealth services via Audio Only; addition of Violence Prevention - Community Support Team (VP-CST) services into Group B services table; addition of notations regarding Crisis Stabilization Services change in units; and change to the use of the HK modifier when providing Community Support Services in a residential setting.
- Specialized Mental Health Rehabilitation Facilities - Note added regarding using appropriate revenue code for add-on payments.
- Inpatient Hospital - Guidance added regarding how to bill when a patient is transported to another facility for services and returns to admitting hospital the same day, and clarification added for Aetna Better Health of Illinois.
- Anesthesia - Guidance added regarding billing for office-based pain management services.
- Transportation Services - Clarification on Medicare-Medicaid Alignment Initiative (MMAI) billing for non-emergency ground ambulance and addition of the Certificate of Transportation Services form for non-emergency transports originating at a member's residence.
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