Staff Contact

Susan Gaines
Director of Community Development & Financial Services
(217) 541-7409

sgaines@iphca.org

Medicaid

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 Mandatory Managed Care

Medicaid has worked to expand managed care by enrolling Illinois Medicaid and All Kids clients into care coordination in five mandatory managed care regions:  Rockford, Central Illinois, Metro East, Quad Cities, and the greater Chicago area.  Through this program over 60% of Illinois Medicaid clients are now served through Managed Care Organizations (MCOs).  Voluntary managed care is also available in other counties.  The HFS care coordination webpage has multiple resources including;

 

The latest version of the model contracts between the state and MCO are available.

 

Client Enrollment Services

HFS subcontracted to provide client enrollment services which are available via the enroll HFS website and phone support.   The website is a portal for client managed care materials and information.  It includes interactive search and listing of available providers by geography or provider name, enrollment materials, and client benefit and plan comparison searches.

 

Medicaid Provider Enrollment

As of August 2015 Medicaid provider enrollment is managed through an online system called IMPACT.  IMPACT software users must first register themselves to obtain a single sign-on.  Directions are available here.  Registering as a Medicaid rendering provider in Illinois requires the provider have several pieces of information ready, detailed here, before beginning the online enrollment process. If you are enrolling for the first time as an FQHC or adding a new site to an existing FQHC please contact sgaines@iphca.org for tips specific to FQHCs.  Members may access an instructional IMPACT webinar and FQHC specific enrollment documentation here

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 are Appendix 5 which includes error codes and Appendix 12 which contains the Medicaid co-pay schedule.

HFS Managed Care Manual

This Managed Care Manual gives background and resources for providers enrolled in Medicaid but does not supersede, modify or replace provider contracts with the individual MCOs. 

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.

Technical Assistance

IPHCA staff is able to assist members with questions regarding HFS including enrollment, billing, payment analysis, Medicaid Cost Reporting, and programs such as Illinois Health Connect, Dentaquest and MCO opportunities, etc. Contact Susan Gaines at (217) 541-7409 or sgaines@iphca.org.

 

IPHCA Springfield Office
500 S. Ninth St., Springfield, IL 62701

IPHCA Chicago Office

542 S. Dearborn St., Suite 300, Chicago, IL  60605