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 |
