Date: October 27, 2022
To: Enrolled Community Mental Health Centers; Behavioral Health Clinics; and Independent Practitioners: Psychiatrists, Licensed Clinical Psychologists, and Licensed Clinical Social Workers
Re: Updated Community-Based Behavioral Health Fee Schedule and Billing Guidance
This notice informs providers delivering services pursuant to the Handbook for Providers of Community-Based Behavioral Health Services (CBS) of updates to the corresponding CBS fee schedule and provides associated billing guidance.
Increase in Reimbursement Rates for Certain CBS Fee Schedule Services
As announced via public notice, the reimbursement rates for certain services provided by community-based behavioral health providers have been increased effective for dates of service on and after July 1, 2022. The fee schedule for providers of community-based behavioral health services has been updated to reflect these changes.
The Department will not adjust any fee-for-service (FFS) claims that have already been adjudicated and paid at the old rates. Providers will need to submit replacement claims if the provider's usual and customary charges would prompt the replacement claims to adjudicate at the updated higher rates.
The Department will accept electronic transactions submitted through MEDI or via 837P files to replace a payable or pending-payable FFS claim if submitted within 12 months from the original paid voucher date. To replace a single service line or entire claim, enter Claim Frequency "7." Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide.
Billing for Integrated Assessment and Treatment Planning (IATP): Licensed Practitioner of the Healing Arts (LPHA) Review
Providers were informed by provider notice issued July 5, 2022 of the introduction of IATP: LPHA Review as a reimbursable service effective for dates of service on and after July 1, 2022. Providers were instructed to hold claims for IATP: LPHA Review until the Department indicated it was ready to accept FFS claims. The Department has now completed the necessary programming; providers should proceed with submitting any claims for IATP: LPHA Review services with dates of service on or after July 1, 2022.
Providers will receive 180 days from the date of this notice to submit IATP:LPHA Review claims that they have held. If time overrides become necessary, providers should direct requests for FFS claims to a community mental health center billing consultant in the Bureau of Professional
and Ancillary Services at 877-782-5565, option sequence 1, 2, 4, then 8. Managed care questions should be directed to the applicable HealthChoice Illinois (HCI) managed care organization (MCO) plan.
Kelly Cunningham, Administrator
Division of Medical Programs