Services eligible for the enhanced payments will initially be paid at the department’s fee schedule rate. The incremental increases, or the difference between the department’s fee schedule rate and the rate allowed under the ACA, will be paid as adjustments.
The department is currently processing adjustments for dates of service January 1, 2013 through June 30, 2013. After the initial adjustments are completed, they will be processed on a monthly basis.
Providers will begin receiving remittance advices over the next several days. These adjustments can be identified by the following:
Bureau
Code: “D – Bureau of Comprehensive Health Services NIPS/ Pharmacy”
Process
type/Reason codes:
22D/
3313-ACA PCP Payment (Use for ACA payment add on only)
22C/
3314-ACA PCP Payment Void (Use for void of ACA payment add on only)
Please
note: During the first three weeks of adjustment processing, the
adjustment amounts for vaccine administration were inadvertently reduced by
$6.40 each. That problem has been corrected. The department will
make an additional payment adjustment of $6.40 per occurrence for the affected
claims.
(Important HFS Notice Right to Your Email Inbox: Make sure you are signed up to receive HFS provider notices and bulletins that have been posted to the HFS website. You can sign up for several specific provider categories. http://www.hfs.illinois.gov/provrel/)
