Enhanced Payments for Eligible Primary Care Services Scheduled to End December 31, 2014 (from HFS)

12/03/14

Informational Notice

To: Participating Primary Care Physicians (PCPs)

Re: Enhanced Payments for Eligible Primary Care Services Scheduled to End December 31, 2014

This informational notice provides information as part of the enhanced payments for eligible primary care services which is scheduled to end with dates of service beginning January 1, 2015.

Section 1202 of the Affordable Care Act (ACA) required Medicaid programs to pay fees to designated physicians that were no less than the Medicare fee schedule in effect for 2013 and 2014 or the fee schedule rate that would result from applying the 2009 Medicare physician fee schedule conversion factor to the 2013 or 2014 Medicare payment rates, whichever is greater. These enhanced reimbursement rates applied to payments for dates of service January 1, 2013 through December 31, 2014.

Due to the lack of continued federal funding for these enhanced reimbursement rates, the department will discontinue the payment of the enhanced rates for dates of service beginning January 1, 2015.

HFS will continue to monitor activities by Congress regarding a continuation of the enhanced reimbursement rates for dates of service on or after January 1, 2015. In the event that Congress approves the enhanced federal funding for these services, HFS will notify providers of the process for continued reimbursement.

Theresa Eagleson, Administrator
Department of Medical Programs

Preventive Visit Claim Denials (from HFS)

12/03/14

Informational Notice

To: Enrolled Physicians, Advanced Practice Nurses, Federally Qualified Health Centers, Rural Health Clinics, Encounter Rate Clinics and Local Health Departments

Re: Preventive Visit Claim Denials

The department’s coding system regarding preventive visits was previously changed in response to audit findings and limits on preventive visits were set as follows:

• For children birth through 2 years, the number of preventive visits allowed followed the periodicity schedule found in Topic HK-203.11 of the Healthy Kids Handbook.
• For individuals age 3 and older, including adults, one preventive visit per year was allowed.

These changes inadvertently caused some claims received on or after November 1, 2012 through September 15, 2014, to be denied. All preventive services within the CPT range of 99381-99397 that were billed within the maximum time limit of another preventive visit were denied. The error code generated was X11- Procedure Conflicts with Program Limits.

The department recognizes that preventive visits may be required in excess of the recommended limits and has modified the system limits. Providers must re-bill the department for preventive visits that rejected X11 with dates of service November 1, 2012 through September 15, 2014.

A time override has been systematically authorized for claims resubmitted electronically, provided they match the claims that previously rejected X11. Claims that are rebilled on the HFS 2360, Health Insurance Claim Form, will require manual overrides. Instructions for the paper override process are explained in detail on the department’s Non-Institutional Provider Resource webpage. All claims, electronic and paper, must be submitted and received by the department between 11/10/2014 and 05/14/2015.

Questions regarding this notice should be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs

IHC 2014 Provider Survey

Action Needed:  IHC 2014 Provider Survey

To:  All IHC Primary Care Providers
From:  IHC Medical Director Alvia Siddiqi, MD, FAAFP

Date:  10/14/2014

Illinois Health Connect (IHC) PCCM is performing a statewide survey to assess the satisfaction of IHC PCPs and their practices with the IHC program and to establish goals for potential quality improvement.   The PCP or other practice staff most familiar with the IHC program should complete this survey.  Your answers are important in assessing the effectiveness of the IHC program.  All responses are strictly confidential and de-identified prior to data analysis.  If you have any questions about the survey or about the IHC program, please call the IHC Provider Services Help Desk at 1-877-912-1999, extension 3. 

Please use the ONLINE SURVEY LINK at the following website address to complete this survey online:
https://www.surveymonkey.com/r/2014ihcprovidersurvey

This survey and a live link to the online survey are posted on the IHC Provider Notices webpage on the IHC website at the following link: http://www.illinoishealthconnect.com/provider/notices.aspx .  Alternatively, you may download and fax the completed survey to 847-995-1021.      

IHC Provider Services thanks you for your participation! 

Restoration of Podiatric Services (from HFS)

09/23/14

Informational Notice

To: Participating Podiatrists

Re: Restoration of Podiatric Services

As a result of Public Act 098-0651(pdf), effective October 1, 2014, coverage for podiatric services for adults will be restored to the level prior to the July 1, 2012, implementation of Public Act 097-0689 (pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act. Changes will not be made to coverage of podiatric services for children through age 20. Those services were not changed under the SMART Act.

Covered services will be listed on the Podiatrist Fee Schedule posted on the department’s website.

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs

New Webpages on the Healthcare and Family Services (HFS) Website (from HFS)

09/19/14

Informational Notice

To: All Enrolled Providers

Re: New Webpages on the Healthcare and Family Services (HFS) Website

The purpose of this notice is to inform providers of two new webpages available on the Healthcare and Family Services (HFS) website.

The Claims Processing System Issues webpage contains information regarding system issues. The link provides detailed information such as the problem, providers impacted, the procedure codes impacted, the problem begin date and problem fix date, and the final resolution.

HFS will post notification on the Claims Processing System Issues webpage when experiencing system problems. Once the system problems have been resolved, HFS will update the Website.

The Non-Institutional Providers (NIP) Resources webpage is designed to assist Non-Institutional Providers with a location that consolidates all commonly used links at one site. Providers can access HFS billing and payment information as well as Frequently Asked Questions and Answers concerning billing and claims processing.

Providers are encouraged to check these webpages routinely for updates to issues affecting their claims and especially prior to contacting a billing consultant.

Providers can register to receive e-mail notification when new provider releases are posted at the HFS Provider Releases and Bulletins E-mail Notification Request webpage. Please select all specific provider types that apply as well as All Medical Assistance Providers in order to receive all pertinent information.

Any questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services (for non-institutional and pharmacy providers) or to the Bureau of Hospital and Provider Services (for institutional providers) at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs

Timely Filing Claim Submittal for Non-Institutional Providers (from HFS)

09/12/14

Informational Notice

To: Participating Medical Assistance Providers

Re: Timely Filing Claim Submittal for Non-Institutional Providers

The purpose of this notice is to remind providers of the timely filing requirements for Non-Institutional claims.

To be eligible for Medicaid reimbursement, providers and suppliers must file claims within a qualifying time limit. A Medicaid primary claim received on or after July 1, 2012 will be considered for payment only if it is received by the department no later than 180 days from the date on which services or items are provided. Rebilled claims, as well as initial claims, received more than 180 days from the date of service will not be paid.

The department has created documents to assist providers with the department’s timely filing override policy and may be found on the Non-Institutional Providers (NIP) Resources webpage.

• Timely Filing Claim submittal for Non-Institutional Providers (pdf)
• Timely Filing Override Questions and Answers (pdf)
• HFS 1624, Override Request Form (pdf)

Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator
Division of Medical Programs

Integrated Care Program Update- City of Chicago (From HFS)

09/12/14

Informational Notice

To: All Medical Assistance Providers

Re: Integrated Care Program Update- City of Chicago

The Department of Healthcare and Family Services (HFS) is in the final stages of the Integrated Care Program (ICP) expansion. ICP is for seniors and persons with disabilities (SPDs) age 19 or older who are eligible for Medicaid but not eligible for Medicare. HFS has completed mailing enrollment material to all city of Chicago residents who are eligible for ICP. HFS expects those city of Chicago individuals will have enrolled in ICP by September 1, 2014.

ICP is now operating in all areas of the five mandatory managed care regions, including: the Greater Chicago Region, the Rockford Region, the Central Illinois Region, the Metro East Region and the Quad Cities Region.

SPDs in the city of Chicago will be enrolled with one of the following types of organizations: Managed Care Organizations (MCOs), Managed Care Community Networks (MCCNs), and Coordinated Care Entities (CCEs).

Managed Care Organizations (MCOs) are the traditional insurance-based Health Maintenance Organizations. They are paid on a full-risk capitated basis to cover almost all Medicaid services. Providers will need to bill these entities directly in order to get paid. Providers will also have to make sure they follow the MCOs’ utilization policies and procedures, including procedures for prior authorization and billing. Providers with enrollees in an MCO should work with the Integrated Care Team to coordinate care for these individuals. The Department electronic eligibility systems clearly identify under the ‘Managed Care Organization segment’ which MCO an individual is enrolled.

Managed Care Community Networks (MCCNs) are provider-owned and governed entities that operate like MCOs on a full-risk capitated basis. Just as with MCOs, providers will need to bill these entities directly in order to get paid. MCCN enrollment in the HFS eligibility systems will look identical to MCO enrollment. Providers will also have to make sure they follow the MCCNs’ utilization policies and procedures, including procedures for prior authorization and billing. Providers with enrollees in an MCCN should work with the Integrated Care Team to coordinate care for these individuals. The Department electronic eligibility systems clearly identify under the ‘Managed Care Organization segment’ which MCCN an individual is enrolled.

Care Coordination Entities (CCEs) are provider-based organizations that will be paid a fee by the Department to coordinate care for their enrollees. All Medicaid covered services will continue to be covered by the state. Providers will need to bill the state as they do today. If services require prior approval in the fee-for-service system today, they will continue to require it under CCEs. The process for obtaining prior approval from the state remains unchanged. Providers with enrollees in a CCE should work with the CCE Care Team to coordinate care for these individuals. The Department electronic eligibility systems will state “no MCO information for this inquiry” and will clearly identify the CCE in which an individual is enrolled under the ‘Care Coordination Entity segment.’

It is imperative that providers check Department electronic eligibility systems regularly to determine beneficiaries’ enrollment in a plan and to ensure your clients can continue care with you. The Recipient Eligibility Verification (REV) System, the Automated Voice Response System (AVRS), and the Medical Electronic Data Interchange (MEDI ) system will identify the care coordination plan in which the beneficiary is enrolled. It is also imperative that providers of all types join managed care networks in order to ensure timely payment.

Different regions will be served by different managed care entities. Please review the Department’s Care Coordination Expansion Map (pdf), which includes the ICP plans.

James Parker, Deputy Administrator
Division of Medical Programs

MCO, MCCN, and CCE CONTACT INFORMATION FOR CITY OF CHICAGO ICP MEMBERS

The contact information below lists the Provider Services Hotline Numbers for the Managed Care Organizations and Managed Care Community Networks that serve the Integrated Care Program members:

Provider	Contact Information
Aetna Better Health	866-212-2851 www.aetnabetterhealth.com/illinois
Blue Cross/Blue Shield	888-657-1211 www.bcbsil.com
Community Care Alliance of Illinois (MCCN)	866-871-2305 network@ccaillinois.com
County Care (MCCN)	312-864-8200 www.countycare.com
Health Spring of Illinois	866-486-6065 www.careplanil.com
Humana Health Plan	800-626-2741 www.humana.com
IlliniCare Health Plan	866-329-4701 www.illinicare.com
Meridian Health Plan	866-606-3700 www.mhplan.com

The information below provides the name and contact information of the CCEs:

Name of CCE Lead Entity	Contact Information
Be Well Partners in Health	866-537-9695 www.bewellpartnersinhealth.com
Healthcare Consortium of Illinois (EntireCare)	708-841-9515 www.hcionline.org
Together 4 Health	855-684-1700 www.t4hillinois.org
Next Level Health Partners	1-844-807-9734 www.nextlevelhealthil.com

(From HFS) Tobacco Cessation Counseling Services and Pharmacotherapy for Pregnant and Post-Partum Women Age 21 and Over and Children through Age 20

08/26/14

Informational Notice

To: Enrolled Physicians; Advanced Practices Nurses (APNs); Federally Qualified Health Centers (FQHCs); Rural Health Clinics (RHCs); Encounter Rate Clinics (ERCs); Certified Health Departments; School-Based Clinics; and Pharmacies

Re: Tobacco Cessation Counseling Services and Pharmacotherapy for Pregnant and Post-Partum Women Age 21 and Over and Children through Age 20

Section 4107 of the Affordable Care Act (P.L. 111-148), amended Title XIX (Medicaid) of the Social Security Act to provide for Medicaid coverage of comprehensive tobacco cessation services for pregnant and up to 60-day post-partum women age 21 and over, including both counseling and pharmacotherapy, without cost sharing.

The Illinois Department of Healthcare and Family Services (HFS) has filed administrative rules to formalize coverage of tobacco cessation counseling services and pharmacotherapy for pregnant and up to 60-day postpartum women. While children through age 20 have been eligible to receive tobacco cessation services under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit, these counseling procedures and pharmacotherapy also apply to this population.

Counseling Procedure Codes

Effective with dates of service on and after January 1, 2014, tobacco cessation counseling services for the above populations may be a separately billable service under the following procedure codes:

99406 – Smoking and Tobacco Use Cessation Counseling Visit; Intermediate, Greater than 3 Minutes Up to 10 Minutes

99407 – Smoking and Tobacco Use Cessation Counseling Visit; Intensive, Greater than 10 Minutes

Duration of Counseling

For pregnant and up to 60-day post-partum women age 21 and over, HFS will reimburse up to a maximum of three quit attempts per calendar year, with up to four individual face-to-face counseling sessions per quit attempt. The 12 maximum counseling sessions include any combination of the two procedure codes identified above. These counseling sessions must be provided by, or under the supervision of, a physician, or by any other health care professional who is legally authorized to furnish such services under State law, and who is authorized to provide Medicaid covered services other than tobacco cessation services.

In addition, the patient’s medical record must be properly documented with provider signature, and include the total time spent and what was discussed during the counseling session, including cessation techniques, resources available and follow-up.

Note: Children through age 20 are not restricted to the maximum twelve counseling sessions.

Pharmacotherapy

The department covers FDA-approved nicotine replacement therapy in multiple forms, as well as two prescription medications indicated for use as an aid to smoking cessation. Providers may refer to the department’s Drug Prior Authorization webpage to determine specific drug coverage and prior approval requirements. Nicotine replacement duration of therapy is normally limited to three months in a year; however, duration limitations may be overridden by the department through the prior approval process on an individual patient basis. To request prior approval for a specific drug, please link to the Drug Prior Approval Information webpage.

Please note, per U.S. Public Health Service published guidelines, pharmacotherapy for tobacco cessation is not recommended for pregnant women due to lack of evidence regarding its safety and effectiveness in pregnant women; however, its use may be evaluated on an individual basis by the woman and her physician.

Illinois Tobacco Quitline

HFS promotes smoking cessation with all participants, but is particularly interested in pregnant women and youth. HFS encourages all providers to take advantage of the resources available to address smoking cessation including information provided by the Illinois Department of Public Health at the Illinois Tobacco Quitline website or by calling 1-866-QUIT-YES (1-866-784-8937).

Any questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Theresa Eagleson, Administrator
Division of Medical Programs

Illinois Family Planning Action Plan Announced

Illinois Family Planning Action Plan Announced

The draft of the Illinois Family Planning Action Plan was announced on August 20, 2014. Its goal is to: “increase access to family planning services for women and men in the Medicaid Program by providing comprehensive and continuous coverage to ensure that every pregnancy is a planned pregnancy.” About 1 million girls and women in the Medicaid program are of childbearing age, and 54% of all babies born in Illinois are through Medicaid.

To achieve this goal, HFS will increase provider reimbursement rates, improve operational policies, and will work closely with Health Plans and providers to make sure that comprehensive family planning services are offered to our clients. Please review the draft Family Planning Action Plan and our new Family Planning website and offer any comments or other feedback by September 15, 2014. Thank you for your ongoing interest in the Medicaid Program.

Cost Sharing Adjustments (From HFS)

08/20/14

Informational Notice

To: Participating Physicians, Chiropractors, Podiatrists, Optometrists, Advance Practice Nurses, Federally Qualified Health Center (FQHC), Encounter Rate Clinic (ERC), Rural Health Clinic (RHC), Hospitals and Pharmacies

Re: Cost Sharing Adjustments

The purpose of this notice is to inform providers that the department is in the process of issuing adjustments for the following copayment deductions:

• An adjustment of $1.65 (the difference between a copayment of $3.65 and $2.00) will be processed for All Kids Share participants for whom the department deducted a copayment for an office visit, clinic visit, brand name prescription drug or hospital emergency room visit for dates of service August 30, 2012 through September 27, 2012.
• An adjustment of $8.00 (the difference between a copayment of $10.00 and $2.00) will be processed for All Kids Share participants for whom the department deducted a copayment for non-emergency use of the emergency room for dates of service August 30, 2012 through September 27, 2012.
• An adjustment of $3.65 will be processed for All Kids Assist participants for whom the department deducted a copayment for non-emergency use of the emergency room for dates of service July 16, 2012 through March 31, 2013.

The department has systematically identified providers who will receive the adjustments. The copayment adjustments will be tied to the original claim from which the copayment was deducted; which will identify both the participant and the date of service. If you receive a copayment adjustment, and you collected the copayment from the participant, you must refund/balance adjust the amount of the copayment adjustment to the participant. If you did not collect the copayment, no action is required.

The copayment adjustments will be processed over the next several weeks. The following adjustment reason codes will identify the copayment adjustments on the remittance advice: 3535 (institutional-hospital providers), 3223 (non-institutional providers) and 8730 (pharmacy providers).

Questions regarding this notice should be directed as follows:

- Hospitals may contact the Bureau of Hospital and Provider Services, by e-mail at hfs.bchs@illinois.gov or by telephone at 1-877-782-5565.

- Physician offices, clinics and pharmacies may contact the Bureau of Professional and Ancillary Services by e-mail at HFS.Pharmacy@illinois.gov or by telephone at 1-877-782-5565.

Mashelle Rose, Chief	Lisa Arndt, Chief
Bureau of Hospital and Provider Services	Bureau of Professional and Ancillary Services