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.

ICD-10 CM Implementation - Claim submission Requirements and FAQ's

June 17, 2015

To: All Medical Assistance Program Providers
Re: ICD-10-CM Implementation - Claim Submission Requirements

This notice serves to inform providers of specific claim information required as a result of the federally- mandated conversion from the ICD-9-CM code set to the ICD-10-CM code set effective October 1, 2015. These instructions do not apply to dental claims billed on the ADA claim form to the department’s dental program contractor, DentaQuest of Illinois.

General Information  HFS will reject claims that are billed with both ICD-9-CM and ICD-10-CM diagnosis codes on the same claim.

HFS will reject claims that are billed with both ICD-9-CM and ICD-10-CM procedure codes on the same claim.

837 Professional and Paper Claims  ICD-9-CM diagnosis codes will no longer be accepted on electronic and paper claims with service dates on or after October 1, 2015. These claims must be submitted with the appropriate ICD-10-CM codes. The department is revising paper claim forms HFS 2210 (durable medical equipment and supplies); HFS 2211 (laboratory/portable X-ray); and HFS 2212 (health agency) to accommodate expanded ICD-10 diagnosis coding. For providers who bill on these claim forms, paper claims with ICD-10 diagnosis codes with dates of service on or after October 1, 2015 must be billed on the revised forms. These revised forms will have a revision date of R-2-15 in the bottom left corner of the form and may be ordered beginning in August, 2015, from the Medical Forms Request page of the department’s website.
For claims with dates of service prior to October 1, 2015, submit with the appropriate ICD-9-CM
codes. Either the current version or the revised version of the paper HFS 2210, HFS 2211, and HFS
2212 can be used to submit claims with ICD-9 diagnosis codes.

Claims for certain items or supplies (such as equipment rentals or monthly supplies) should be split based on service dates pre- and post-October 1, 2015.


837 Institutional and Paper Claims   ICD-9-CM diagnosis and procedure codes will no longer be accepted on electronic and paper claims with dates of discharge or Through Dates of service on or after October 1, 2015. These claims must be submitted with the appropriate ICD-10-CM codes. Exception: Claims for emergency department and observation that span October 1, 2015 should not be split. The appropriate ICD-9-CM diagnosis code should be used based on the service From Date.

For claims with dates of discharge or Through Dates of service prior to October 1, 2015, submit with the appropriate ICD- 9-CM codes.
Series claims should be split based on service dates pre- and post-October 1, 2015.
All per diem-reimbursed claims that span October 1, 2015 must be split based on service dates pre- and post- October 1, 2015.

All DRG-reimbursed claims that span October 1, 2015 must be billed admission through discharge.

eQ Health Review - Inpatient Per Diem Reimbursed Stays Crossing October 1, 2015
Per diem reimbursed claims that are subject to continued stay review by the department’s Quality Improvement Organization, eQHealth Solutions, Inc., must be split pre- and post-October 1, 2015. Hospitals must get certification for the days prior to October 1, 2015, and also for the days after October 1, 2015.

Per diem reimbursed interim claims (those with a FL 4 Frequency Digit of 3 or 4) that contain a From Date on or after October 1, 2015 cannot contain an Admission Date prior to October 1. The department is modifying its edits for this situation to allow hospitals to bill an interim claim that contains an Admission Date of October 1, 2015.


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
 
 
Frequently Asked Questions
1.  When will HFS begin to accept ICD-10 claims? HFS will start accepting claims using ICD-10 codes on October 1, 2015 for dates of service/discharge on or after October 1, 2015.

 2. How will HFS determine whether ICD-10 or ICD-9 is the appropriate code set to use?

The date of service or the date of discharge for inpatient claims will be the deciding factor in determining which codes set is appropriate. If the date of service/discharge is before October 1, 2015, then ICD-9 codes should be used on the claim. For any dates of service/discharge occurring on or after October 1, 2015, use ICD-10 codes on the claim. Exception: Claims for emergency department and observation that span October 1, 2015 should not be split. The appropriate ICD-9-CM diagnosis code should be used based on the service From Dat


3. Do you plan on converting ICD-10 codes to ICD-9 codes?  HFS will not convert claims. Based upon the date of service/discharge, a claim will be processed as either an ICD-10 or ICD-9. Claims without the appropriate code set for the date of service/discharge will not be accepted.
 4. Will HFS still accept ICD-9 codes after October 1, 2015?
 Yes, the department will still accept claims with ICD-9 codes after October 1, 2015. However, ICD-9 codes will only be accepted for claims with dates of service/discharge before October 1, 2015. Any dates of service/discharge after September 30, 2015 must use ICD-10. See Exception, Question 2.



5. Will we be able to submit an ICD-9 claim with a date of service/discharge later than October 1, 2015?  No, any claim with an ICD-9 code submitted for a date of service/discharge greater than September 30, 2015 will be rejected.  See Exception, Question 2. 
6. Does HFS have staff dedicated to ICD-10 conversion?  Yes, HFS has a dedicated team tasked specifically to ICD-10 conversion.
 7. How is HFS readiness when considering ICD-10 conversion?  Currently, HFS is on task and all requirements for ICD-10 conversion are on schedule. HFS will "go live" with ICD-10 on October 1, 2015.



8. When will HFS publish policy and notices concerning ICD-10?  The goal of the Department is to get notices and policies concerning ICD-10 published by July, 2015.
 9. Will vendors be able to test with HFS before October 1, 2015?  Due to technological constraints, HFS will not be providing a platform for end to end testing for external vendors.
 10. Do all HFS-enrolled providers have to use ICD-10 coding?  Yes, all providers whose claims require a diagnosis code must use ICD-10 diagnosis codes on the claim. All inpatient hospital claims must use ICD-10 procedure coding as well.