IMPACT Provider Revalidation-Due Date Extensions

                 

Page Content

IMPACT Provider Revalidation-Due Date Extensions

​To:	​Participating Medical Assistance Providers
​Date:	​December 28, 2015
​Re:	​IMPACT Provider Revalidation-Due Date Extensions

---

The due dates have been extended for provider revalidation. The provider community has done a great job working with the Department to revalidate provider information and we appreciate all of your efforts.

 

Facility/ Agency/Organizations (FAOs) revalidation has been extended to March 15, 2016.

 

Based on the above requirement and understanding that FAOs and groups must enter the IMPACT system prior to individual providers; the Department will further extend the revalidation due date for Individual/Sole providers to June 30, 2016.

 

More information on the IMPACT system plus frequently asked questions, webinars and other training guides are available at the IMPACT website.

 

If you have additional questions or need assistance, please contact the IMPACT Help Desk:

 

• By email: IMPACT.Help@Illinois.gov 
•  By phone: (877) 782-5565 Select option #1.

 

 

Felicia F. Norwood

Director

IMPACT (Illinois Medicaid Program Advanced Cloud Technology) Provider Revalidation

               

Page Content

IMPACT (Illinois Medicaid Program Advanced Cloud Technology) Provider Revalidation

​To:	​Participating Medical Assistance Providers
​ Date:	​November 4, 2015
​Re:	​IMPACT (Illinois Medicaid Program Advanced Cloud Technology) Provider Revalidation

---

This Informational Notice is a reminder that Facility/Agency/Organizations (FAOs) are required to revalidate their provider enrollment applications in IMPACT on or before December 31, 2015. 

 

Based on the above requirement and understanding that FAOs and groups must enter the IMPACT system prior to individual providers, the Department has extended the due date for Individual/Sole providers to March 15, 2016.

 

More information on the IMPACT system plus frequently asked questions, webinars and other training guides are available at the IMPACT website.  

 

If you have additional questions or need assistance, please contact the IMPACT Help Desk:

• By email: IMPACT.Help@Illinois.gov
•  By phone: (877) 782-5565 Select option #1.

 

 

Felicia F. Norwood

Director

Clinical Directors Network invites you to join us for a live Webcast: National Nursing Centers Consortium, Lead Poisoning: Why Some Children are Still at High Risk and What You Can Do About It

tttt     Clinical Directors Network, Inc. (CDN) Invites you to join us for a live Webcast: National Nursing Centers Consortium Lead Poisoning: Why Some Children are Still at High Risk and What You Can Do About It       In honor of Lead Poisoning Prevention Week, the National Nursing Centers Consortium presents a webinar entitled "Lead Poisoning: Why Some Children are Still at High Risk and What You Can Do About It". This webinar, for all health and social service providers, will describe the epidemiology of lead poisoning, and explore the sources of lead exposure still found in the environment.  We will outline the factors that identify most 'at risk' children, clarify who should be screened, and discuss when and how elevated levels should be reported.

SPONSOR:     PRESENTED BY:   Marilyn V. Howarth, MD, FACOEM  Director of the Community Outreach and Engagement Core for the Center of Excellence in Environmental Toxicology at the University of Pennsylvania   Rachael Greenberg, MPH Public Health Project Manager, National Nursing Centers Consortium.     Monday, October 26th, 2015 12:00 PM - 1:00 PM EDT       This session is also pending for up to 1.0 prescribed CME credits through the American Academy of Family Physicians (AAFP). For the purposes of American Nurses Credentialing Center (ANCC) certification and re-certification, participants may use these contact hours.    This webcast is brought to you by  National Nursing Centers Consortium,  a PHMC affiliate. Sponsored in part by the U.S. EPA Environmental Education Program.   Check out our new website! www.CDNetwork.org To view additional webcasts in this series.

 

ICD-10-CM Implementation

Informational Notice



Date: September 25, 2015

To: All Medical Assistance Program Providers

Re: ICD-10-CM Implementation

This notice informs providers that the federally-mandated conversion from ICD-9 to ICD-10 codes will be implemented on October 1, 2015. Federal Centers for Medicare and Medicaid Services (CMS) had previously delayed the deadline for implementation from 10/1/2014 to 10/1/2015.

CMS provides extensive information, fact sheets, tools, and resources for providers, vendors and payers for implementing ICD-10. For more information, visit the CMS website with ICD-10 updates. Also, for additional information regarding claims submission requirements see the provider notice dated June 17, 2015 (pdf).
Questions pertaining to professional billing may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565, Option 3. Questions pertaining to institutional billing may be directed to the Bureau of Hospital and Provider Services at 1-877-782-5565, Option 2.



Felicia F. Norwood
Director

All Kids Application Agent and Medicaid Presumptive Eligibility (MPE) Alert For Participating FQHCs, ERCs, Local Health Departments, RHCs, School Based Health Clinics, School Based/Linked Health Center Services, Hospital Based ClinicsProvider

09/15/15

Informational Notice

MPE Provider Alert Participating Federally Qualified Health Centers (FQHC), Encounter Rate Clinics, Local Health Departments, Rural Health Clinics, School Based Health Clinics, School Based/Linked Health Center Services, Hospital Based Clinics

Re: All Kids Application Agent and Medicaid Presumptive Eligibility (MPE) Provider Alert           

Dear Provider,

An All Kids Application Agent and Medicaid Presumptive Eligibility (MPE) Provider Alert is posted to the HFS website for your review. The Medicaid Presumptive Eligibility (MPE) Instructions for providers manual is revised and posted on the HFS website for your review. Additionally, the following MPE forms are revised and are attached to this notice for your immediate use. If you have any questions about this communication or the MPE program, please contact an All Kids liaison:

AKAA Liaison for those located North of I-80
Phone: 1-312-793-5270 Fax: 1-312-793-5278

AKAA Liaison for those located South of I-I80
Phone: 1-217-524-7156 Fax: 1-127-557-4274 .

All Kids Application Agent and Medicaid Presumptive Eligibility (MPE) Provider Alert for September 2015

• Proof of Pregnancy
• MPE Limit per Pregnancy
• Social Security Number Requirement for MPE on abe.illinois.gov
• Declaration of Illinois Residency
• Countable Income for MPE
• Family Size Based on Age
• Medicaid Presumptive Eligibility Instructions for Providershas been revised and is online
• Revised Form 3089 Medicaid Presumptive Eligibility Application
• New Form 3090D MPE Denial Notice
• Fact Sheet on Presumptive Eligibility for Children and Pregnant Women
• Attachments:  Forms 3089, 3090D, 3166

Proof of Pregnancy
The Affordable Care Act (ACA) removed the requirement for verification of pregnancy.  Therefore, proof of pregnancy is not required of applicants for the Medicaid Presumptive Eligibility (MPE) program or any other Illinois Medicaid program including Moms & Babies.  Accept the applicant’s statement of pregnancy. Please enter the estimated date of delivery on the MPE application in ABE or paper application if it is known.
Until the online MPE application in ABE is updated to ask about declaration of pregnancy and the date the pregnancy was declared, use this Alert as guidance regarding pregnancy.
MPE Limit per Pregnancy
The Affordable Care Act (ACA) limits MPE to one approval per pregnancy.  However, HFS will extend the MPE until a final determination of eligibility is made if an application for full medical benefits has been submitted before the initial MPE coverage period ends.
Social Security Number (SSN) Requirement for MPE on abe.illinois.gov
The online application for full medical benefits requires an SSN if the person has an SSN.  However for MPE, the SSN is optional.
Until the online ABE MPE application is updated, applicants who choose not to provide an SSN can mark ‘SSN not available’.
We ask that you encourage MPE applicants who have an SSN to provide it because it helps the Department link the MPE applications to the full Moms & Babies application if submitted, and it expedites authorization of the MPE coverage.
Declaration of Illinois Residency
Applicants for MPE must state they are Illinois residents.  However, there is no requirement defining how long they have been an Illinois resident.
Countable Income for MPE
The MPE income eligibility determination is revised to bring it into alignment with the budgeting methodology used for children’s presumptive eligibility. To determine MPE eligibility, compare the gross monthly income of everyone who is included in the pregnant woman’s family size to the MPE income standard.  Do not deduct any amount from the gross monthly income.
Until the online ABE MPE application is updated, do not enter an amount in the Income Deduction section.  Determine countable monthly income based on this Alert.
MPE Form 3166 MPE Income Worksheet is updated to reflect this change and is attached.
Family Size Based on Age
Family size is considered when determining whether the pregnant woman meets the income standard for MPE.  Family is defined as the pregnant woman, her unborn child(ren), her husband, and children/stepchildren under the age of 19.  If the pregnant woman is under the age of 19 and lives with her parents/stepparents, then the parents and any siblings under age 19 are counted in the family size in addition to her husband, unborn child(ren) and her existing children under 19.
Until the online ABE MPE application help text is updated, determine family size based on this Alert. 
Medicaid Presumptive Eligibility Instructions for Providers has been revised and is online.
Revised Form 3089 Medicaid Presumptive Eligibility Application
Form 3089 is revised to add the declaration of pregnancy question, add the declaration of Illinois residency question, clarify that the SSN is optional and to clarify the MPE eligibility begin date.  Use the Form 3089 attached to this alert.  The form included in the Medicaid Presumptive Eligibility Instructions for Providers has a watermark on it to prevent unauthorized use.
Form 3090D MPE Denial Notice
Federal regulations require notifying the applicant when she does not qualify for presumptive eligibility.  Use one of the following reasons to deny MPE coverage to an ineligible pregnant woman:

• Income exceeds the limit for MPE;
• MPE coverage limited to one time per pregnancy;
• Applicant stated she is not pregnant;
• Applicant stated she is not an Illinois resident; or
• Information needed for an eligibility determination was not provided.

When the applicant fails to provide information about household income or the number of people living with her or will not declare she is pregnant or is an Illinois resident, the applicant is not eligible for MPE.
Until the online ABE MPE application PDF Summary page is updated, use the attached form 3090D/S to notify the pregnant woman of the reason for denial.
If the applicant’s income is over the limit, she may still qualify for Medicaid with a spenddown.  Help the applicant complete and submit a Moms & Babies application.
Presumptive Eligibility for Children and Pregnant Women
We would like to clarify the requirements for child presumptive eligibility and MPE for pregnant women. 

• Applicants must be informed of the minimum information required to start medical coverage right away.  However, we also want applicants to understand that a complete application is required to determine eligibility for medical coverage following the presumptive eligibility period;
• Verification of pregnancy is no longer required for MPE eligibility;
• An applicant for a child must declare the child’s U.S. citizenship or satisfactory immigration status; and
• Applicants are required to declare their Illinois residency.  Declaration of Illinois residency means answering the question, “Are you an Illinois resident?”

Medicaid Payments to those caring for children throught the state will continue during budget impasse

HFS News Release

For Immediate Release:

Friday, July 31, 2015

Medicaid payments to those caring for children
throughout state will continue during budget impasse
  SPRINGFIELD -- Providers offering Medicaid services to children throughout Illinois will continue to receive funding during the budget impasse, the Department of Healthcare and Family Services announced today.

HFS will be making payments to its providers to ensure children in Illinois have access to necessary healthcare services. The department intends to continue this funding until a new state budget is approved. Details of the decision will be developed and announced soon. 

State education and health agencies issue reminder for immunizations as students prepare for new school year

29th Jul, 2015

August marks National Immunization Awareness Month

SPRINGFIELD —  As students are preparing to head back to school, the Illinois State Board of Education (ISBE) and the Illinois Department of Public Health (IDPH) encourage parents and guardians to ensure their children’s immunizations are up to date. There is a new school-entrance immunization requirement for the upcoming school year.

Beginning this fall, a meningococcal conjugate vaccination (MCV4) requirement becomes effective for students entering grades six or 12. Sixth-graders must show proof of one dose of MCV4; 12th-graders must show proof of having received two doses. Twelfth-graders who received the first dose after 16 years of age need only one dose.

In addition, any child entering kindergarten, sixth grade or ninth grade for the first time shall show proof of having received two doses of varicella (chickenpox) vaccine. IDPH’s Immunization Quick Reference Guide provides additional details about the 2015-16 requirements.

“Immunizations are in place to protect students and their families,” said State Superintendent of Education Tony Smith, Ph.D. “It’s important that our students stay healthy so they can remain in the classroom, continuing to learn and grow throughout the year.”

The State of Illinois requires vaccinations to protect children from a variety of diseases before they can enter school. For school entrance, students must show proof of diphtheria, pertussis, tetanus, polio, measles, mumps, rubella, haemophilus influenza type b, hepatitis b, and varicella, as well as pneumococcal  and now meningococcal (depending on age) vaccinations.  For more information about immunizations, including vaccination schedules, visit http://www.dph.illinois.gov/topics-services/prevention-wellness/immunization.

“Although we are seeing fewer cases of many vaccine-preventable diseases, if we don’t continue to vaccinate our children, we will see an uptick and more people become infected. We could experience another outbreak similar to the measles outbreak which occurred in Illinois earlier this year,” said IDPH Director Nirav D. Shah, M.D., J.D.  “Vaccines have been proven to be a safe and effective way to keep children protected against a number of diseases.”

August marks National Immunization Awareness Month, which aims to educate people of all ages about the importance of protecting their health by being immunized against infectious diseases.

In addition to immunizations, all students enrolling in kindergarten -- in a public or private school -- and any student enrolling for the first time in Illinois (with the exception of preschoolers) must also have an eye examination. The eye exam needs to be performed by a licensed optometrist or medical doctor who performs eye exams and is licensed by the Illinois Department of Financial and Professional Regulation. All eye exams must be completed within one year prior to Oct. 15.

Furthermore, all students enrolled in kindergarten, the second, and the sixth grades are required to have a dental examination.

Also, all children must complete a physical examination prior to entering Illinois schools for the first time, prior to the date of entering kindergarten or first grade, prior to entering sixth grade, and prior to entering ninth grade. The exam includes gender and date of birth; an evaluation of height, weight, BMI, blood pressure, skin, eyes, ears, nose, throat, mouth/dental; cardiovascular, respiratory, gastrointestinal, genito-urinary, neurological, and musculoskeletal evaluations; spinal examination; evaluation of nutritional status; lead screening; and other evaluations deemed necessary by the health care provider. Illinois’ health exam requirements are aligned with recommendations by the Advisory Committee on Immunization Practices (ACIP) on adolescent vaccinations.

These student health requirements for entry apply to all schools in Illinois - public, charter, or private. Parents and guardians should contact their health care provider, local health department, or pharmacy to schedule an appointment to receive the recommended and required vaccinations. It is important to keep an immunization record card for your child’s entry into school.

IDPH offers additional immunization information on its website. There is also the Illinois Help Me Grow helpline at 1-800-323-GROW (voice and TTY) for additional immunization information. For parents who may not be able to afford immunizations, the Vaccines for Children program provides vaccines at no cost to children from low-income families. For information, call (312) 746-6050 in Chicago or (217) 785-1455 for the rest of the state.

For additional information about immunizations in Illinois, visit:

• ISBE’s School Health Issues: http://www.isbe.net/school_health.htm#immu
• Administrative Rules for Basic Immunizations: http://www.ilga.gov/commission/jcar/admincode/077/077006650B02400R.html

Article link:  http://www.dph.illinois.gov/news/state-education-and-health-agencies-issue-reminder-immunizations-students-prepare-new-school

 

 

07/10/15

Informational Notice

To: All Medical Assistance Providers

Re: State Fiscal Year 2016

Illinois begins FY 2016 (July 1, 2015 – June 30, 2016) without a State budget and appropriation. While payments from the department will be impacted, beneficiaries remain eligible and the department will be obligated to pay once appropriations are available. Therefore, the department encourages our providers to continue providing services as the following remains:

• Claims for dates of service prior to July 1, 2015, can be paid during the “Lapse Period” out of the appropriation for that fiscal year, i.e., FY 2015, so cash should continue to flow for a time from those services.

• Once a budget is enacted, pending claims with dates of service from FY 2016 (July 1, 2015  - June 30, 2016) would be paid retroactively. 

• Medicaid managed care plans are required to comply with their obligations to pay providers timely, unless the MCO has not received any capitation payment from the State for two consecutive months. MCOs have been paid for May and June. This means that since the MCOs were paid their capitation amounts for May and June, they are subject to the timely payment obligations under their contract with HFS for July and August.

We thank you all for your commitment to providing necessary health care services to Illinois’ 3.2 million beneficiaries, even in this time of uncertainty.



Felicia F. Norwood
Director

Requirements for Enrollment and Revalidation in the New Enrollment System - Illinois Medicaid Program Advanced Cloud Technology (IMPACT)

06/23/15

Informational Notice

To: Participating Medical Assistance Providers
Re: Requirements for Enrollment and Revalidation in the New Enrollment System - Illinois Medicaid Program Advanced Cloud Technology (IMPACT)     

This notice outlines the requirements for enrolling in or revalidating existing information in the new computer-based provider enrollment system, called Illinois Medicaid Program Advanced Cloud Technology (IMPACT).
What you will need to create an INITIAL enrollment in IMPACT
Initial Enrollment is the process a person or entity (who has not previously been enrolled in the HFS Medicaid Assistance program) uses to apply to actively participate as a provider in the Illinois Medical Assistance Program.  If you are an agency or an entity who is a brand new provider, you can enroll any time after the grand opening on August 3, 2015.
(Please note: State Agency-specific enrollment requirements will remain in effect in addition to the IMPACT enrollment requirements listed below.)
If you are an individual provider that serves Medicaid clients, but are not currently required to be enrolled in the Medicaid Management Information System (MMIS/Legacy), you must enroll in the IMPACT system beginning in 2016. (Some examples of these individual providers include: emergency medical technicians, drivers, dispatchers, home makers, interns.)
If you are an agency/entity provider, the following is what you will need in order to enroll:

• A National Provider Identifier (NPI) Number:

An NPI is a unique ten-digit identification number issued by the federal Centers for Medicare & Medicaid Services (CMS).  According to the Health Insurance Portability and Accountability Act (HIPAA), health care providers are required to have an NPI, and to use their NPI in all HIPAA-related transactions.  Providers may have multiple locations attached to one NPI - or they may have a separate NPI for each location.
Not all providers are required to have an NPI Number.  You are required to have an NPI if you are a health care provider who is a HIPAA-covered entity -- whether you are an individual or an organization, you must obtain an NPI.  Under HIPAA, you are a covered health care provider if you electronically transmit health information in connection with a HIPAA standard transaction, even if you use a business associate to do so.
                                                        
To get an NPI visit the National Plan & Provider Enumeration System website at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do   (For more information and to access a tool to help you determine whether you are a covered entity, visit http://www.cms.gov/Regulations-and- Guidance/HIPAA-Administrative-Simplification/HIPAAGen Info/AreYouaCoveredEntity.html  on the CMS website.)

• A certified W-9 tax form on file with the Comptroller:

All “pay to” providers are required to have a certified W9 on file with the Comptroller prior to enrollment in IMPACT.   If you are not enrolled in MMIS, contact your funding agency to submit a W9.  If you are a Rendering/Servicing provider, you are NOT required to have a certified W-9 on file with the Comptroller.  If you are currently claiming through MMIS and receiving payments, you should already be set with your W-9.  (For questions contact the Illinois Department of Healthcare and Family Services, Provider Participation Unit at 877-782-5565.)

• A Taxonomy Number:

This is a code used in billing HIPAA related transactions.  The taxonomy number is selected by the health care provider based upon their education, license/certification and the services being rendered.  Individual providers and organizations are required to indicate their taxonomy when applying for an NPI Number.  All typical providers are required to enter their taxonomy number in IMPACT.

• Licensures or certifications, as needed:

You should ensure that you have your relevant licenses and certifications and that they are up to date, if applicable.  The IMPACT system verifies the following licenses and certifications:

• Illinois Professional Licenses
• Out of State Medical Licenses
• American Board of Medical Specialties (ABMS)
• Clinical Laboratory Improvement Amendments (CLIA)
• American Board for Certification in Orthotics, Prosthetics, and Pedorthics 
• Behavior Analyst Certification 
• Deaf/Hard of Hearing Commission License
• Medicare Certification
• Board of Optician/Contact Lens Certification
• Federal Aviation Administration Certification (More information may need to be included regarding licenses and certifications)

• Other information verified by IMPACT

As needed or as relevant, IMPACT also verifies the following information:

• Criminal History Background Check
• Drug Enforcement Agency Number
• Sanctions
• Vital Statistics
• Provider Basic Information
• Driver's License/State ID
• Vehicle Plate Number
• Vehicle Identification Number
• Safety Training Certificate

• A valid email address

Email will be the primary mode of communication and email is a required field in the IMPACT system; however each practitioner will not need their own specific email address. The groups’ email address can be entered for each provider.  The email address you provide in IMPACT should be monitored frequently since the State will utilize email for most provider communication.

• A supported browser:

Providers must ensure that they have a web browser that is supported by IMPACT.  The supported web browsers (which are free) are:

• Internet Explorer (Version 8 through 11)
• Chrome
• Firefox
• Safari

What you will need if you are a CURRENT MMIS enrollee and need to revalidate your information in IMPACT
​Revalidation is the process a person or entity currently enrolled in the Illinois Medical Assistance Program uses to verify and update their enrollment information on file in IMPACT. Some provider information from the legacy MMIS system will be automatically converted and stored in IMPACT.  You will be required to revalidate before the end of 2015.
This revalidation period applies to entities and sole providers seeking to become Illinois Medical Assistance providers, including those working under Waiver Programs administered by agencies other than the Department of Healthcare and Family Services.  Additionally, revalidation must occur in a particular sequence so that associations may occur between entities and individual providers.  Facilities, Agencies and Organizations (FAOs) must revalidate first, before any individuals (Sole Proprietors or Rendering/Servicing) can associate with these entities.
If you are currently enrolled in the MMIS, in addition to the relevant enrollment requirements listed above, in order to revalidate your information in IMPACT you will need the following:

• Your application ID number: 

The application ID number is a state-assigned number which must be used to access the IMPACT system.  This was sent to providers via postal mail at the beginning of June 2015 and will be sent again around the second week of July 2015.  The ID number is printed on yellow paper inside of a white envelope; and “IMPACT” is printed on the envelope. 
Providers that are not currently enrolled in IMPACT will not receive an Application ID. 
Application IDs will only be mailed to providers who are currently enrolled in the Medical Assistance Program.  Groups and payees are not currently enrolled; therefore they will not receive the yellow sheet with the Application ID.
If you do not receive or do not have your application ID, Help Desk operators can look up your number. The help desk will need the provider’s name, Social Security Number (or Tax ID Number), Date of Birth (if applicable) and NPI.  You can contact the IMPACT Help Desk by email at: IMPACT.Help@Illinois.gov ) or by phone: (877) 782-5565 (Select option #1, and ask to speak with IMPACT staff).  Or you can obtain more information from your funding agency.
More information is available at the IMPACT website http://www.illinois.gov/hfs/impact/Pages/default.aspx  
Additional details will be posted as new information becomes available.
Please check the IMPACT website periodically for updates.
Contact the IMPACT Help Desk

• By email (IMPACT.Help@Illinois.gov)
• Or by phone: (877) 782-5565 (Select option #1, and ask to speak with IMPACT staff).

Illinois Medicaid Program Advanced Cloud Technology (IMPACT) Provider Enrollment Educaitonal Sessions

Informational Notice



Date: June 19, 2015

To: Participating Medical Assistance Providers

Re: Illinois Medicaid Program Advanced Cloud Technology (IMPACT)

Provider Enrollment Educational Sessions

The purpose of this notice is to inform providers that Illinois is announcing IMPACT Educational Sessions scheduled throughout the state and also via webinars.

Scheduled sessions and registration information is posted on the IMPACT website at http://IMPACTinfo.illinois.gov. Providers can register by visiting the IMPACT website and clicking on "Webinars" or very soon on the "Provider Outreach" page.

Educational sessions will also be scheduled in various cities around the state; additional sites will be posted on the web and updated periodically. Please check back for new dates and locations as they are announced. Parking is limited at all locations and ride sharing is encouraged. If you have any questions please contact the IMPACT Help Desk at IMPACT.Help@Illinois.gov or by telephone at (877) 782-5565 option #1 with questions.

We appreciate your assistance and cooperation as we begin this new chapter of the Illinois Medical Assistance Program.

Billing Agents-New Enrollment System for the Illinois Medical Assistance Program

Date:  June 16, 2015

To:      Participating Medical Assistance Providers
Re:      New Enrollment System for the Illinois Medical Assistance Program – Billing Agents

Illinois Medicaid Program Advanced Cloud Technology (IMPACT)

The purpose of this informational notice is to inform billing agents that the State of Illinois is launching a new enrollment process and computer system known as  Illinois Medicaid Program Advanced Cloud Technology (IMPACT).  Billing agents submitting electronic claims to Illinois Medicaid and/or receiving electronic remittances will be required to access the IMPACT system and enroll beginning July 20, 2015.

A billing agent is defined as a business authorized to submit Medicaid Health Insurance Portability and Accountability Act (HIPAA) compliant transactions or a business authorized to exchange Electronic Protected Health Information (ePHI) on behalf of a Medicaid provider or other authorized party.  Billing agents are referred to as Clearing Houses, Software Vendors or Value Added Networks (VAN) depending on their relationship to the health care provider. Billing agents do not render services directly to clients enrolled in the Medical Assistance Program.

This is the first phase in replacing the current Medicaid Management Information System (MMIS).  IMPACT is a web based system that will be accessed and used by all Medicaid providers, waiver program providers and billing agents doing business with the State of Illinois.  Billing agent enrollment into the IMPACT system must occur in the initial phase of the implementation of the IMPACT system so that associations may occur between billing agents, entities and individual providers. While billing/claiming processes will remain unchanged in 2015 and 2016, failure of a billing agent to enroll in the IMPACT system in a timely manner may lead to payment delays for those entities or individual providers who are in need of associating to the billing agent.

As soon as the IMPACT provider portal is made available on-line (the go-live date), billing agents will have a two week window in which the use of the system will primarily be dedicated to their enrollment.  Outreach will be conducted during this time to assist with the enrollment process. Following this two week period, Medicaid providers and waiver program providers will be entering the IMPACT system to validate and update their information if currently enrolled or will be entering the system to initially enroll.  The IMPACT provider portal is designed to require that providers associate (link) to their appropriate billing agent in order for their applications to be approved.

NOTE: Billing agents must enroll into the IMPACT system AND enroll into the  Medical   Electronic Data Interchange (MEDI) System.

Billing agents are encouraged to check the Illinois  IMPACT website regularly, http://IMPACTinfo.illinois.gov in order to stay informed of timelines and specific requirements.

 

Additional details will be posted as new information becomes available. Please check the IMPACT website periodically for updates, and contact the  IMPACT Help Desk at IMPACT.Help@Illinois.gov or by telephone at (877) 782-5565 option #1 with questions.

We appreciate your assistance and cooperation as we begin this new chapter of the Illinois Medical Assistance Program.