The Illinois Department of Healthcare and Family Services (HFS) is the state Medicaid agency. HFS' Medicaid website is a good source for information on the entire Illinois program.
Medicaid Integrated Care Program
Medicaid is working to roll out a managed care program for older adults and adults with disabilities who are enrolled in Medicaid but not enrolled in Medicare for the suburban Cook, DuPage, Lake, Kane, Kankakee, and Will counties. Patient education materials are available along with a website with details.
Medicaid Provider Enrollment
Registering as a Medicaid provider in Illinois requires the provider enrollment application, instructions, and alternate payee forms. The alternate payee form is used so that any time a health center practitioner bills fee-for-service provided on behalf of the health center it directs payment to the health center - not the provider.
Register for Updates on Medicaid and National Health Care Reform
Within the coming years, there will be numerous changes in the Medicaid and All Kids Programs as a result of Medicaid reform and national health care reform. If you would like to receive updates and information from HFS about these changes or any other program information, register online.
HFS Electronic Provider Notices
These notices contain pertinent information for providers regarding covered services and reimbursement policies. HFS no longer mails paper copies of notices and bulletins so you must Register for Email Notification in order to receive the information. When registering for the provider specific categories, providers should also enroll for the “All Medical Assistance Providers” category to ensure notification of all applicable information.
HFS Provider Handbooks
The HFS handbooks include Chapter D-200 which has details specific to encounter rate clinic (FQHC) policies and procedures. Chapter 200 includes the handbook for all services by provider type or service (i.e. Healthy Kids, School-based Health Centers, etc). Chapter 100 is the general handbook of policies and procedures. Of special note is Appendix 5 which includes error codes and Appendices 12, 13, and 14 which contain Medicaid co-pay schedules.
HFS Dental Manual
Dental policy like eligibility, prior authorization, claim submission, provider enrollment, school-based programs, and clinical criteria by age category is included in the Dental Office Reference Manual. Of particular interest are Attachments AA and BB that list covered benefits for children and adults, respectively.
Medicaid Annual Cost Report
Resources for the cost report include instructions and the spreadsheet template. The report is required to be filed with the HFS Bureau of Health Finance no later than 180 days after the end of your fiscal year. The completed FQHC Modified Form 242 and the Certified Financial Statement prepared by an independent Certified Public Accountant must be filed for compliance.
Medicaid Electronic Health Record (EHR) Incentive
A summary of the Illinois program and current program links are available.
Information on the ICD-10-CM transition includes resources and timelines. The transition is required to be complete for dates of service on or before October 1, 2013.
Version 5010 Transition
On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices. Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10. The Version 5010 change occurs well before the ICD-10 implementation date to allow adequate Version 5010 testing and implementation time. If providers do not conduct electronic health transactions using Version 5010 as of January 1, 2012, delays in claim reimbursement may result. The HFS 5010 FAQs webpage offers information on the implementation initiatives in Illinois.
IPHCA staff is able to assist members with questions regarding HFS including billing, payment analysis, Medicaid Cost Reporting, and programs such as Illinois Health Connect, Dentaquest and HMO opportunities, etc. Contact Susan Gaines at (217) 541-7409 or firstname.lastname@example.org.