System Issues Impacting Hospital and Hospice Claims

 

 

 

 

The Illinois Department of Healthcare and Family Services (HFS) has identified a system issue impacting hospital and hospice claims with the assigned Document Control Number (DCN) date of 6274 (September 30, 2016).   Claims were rejected erroneously with various error messages.  The system issue was fixed immediately (October 4, 2016) and only applies to the specific DCN date. 

Providers must rebill these rejected claims. HFS encourages providers to rebill electronically.  If a claim is now past timely filing or requires other special overrides, providers should submit a paper UB-04 with an HFS 1624A UB-04 Override Request Form to HFS staff for review.

Questions may be directed to a billing consultant in the Bureau of Hospital and Provider Services at 1-877-782-5565. 

Dis-Enrollment of Health Alliance Connect Family Health Plan (FHP) Program Enrollees

The Illinois Department of Healthcare and Family Services has posted a new provider notice regarding the Dis-Enrollment of Health Alliance Connect Family Health Plan (FHP) Program Enrollees. You may view the notice from the link below.

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx

 

Dis-Enrollment of Health Alliance Connect Integrated Care Program (ICP) Enrollees

The Illinois Department of Healthcare and Family Services has posted a new provider notice regarding the Dis-Enrollment of Health Alliance Connect Integrated Care Program (ICP) Enrollees. You may view the notice from the link below.

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx

 

MACRA Final Rule Is Here: Wednesday, November 2, 2016 Join CMS's Liz LeBreton for a CHITREC Webinar

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Upcoming Webinars CHITREC makes it a priority to remain at the cutting edge of the industry as your partners in health IT. Join our webinars on hot topics ranging from Meaningful Use to quality improvement initiatives, including Patient-Centered Medical Home and population health, and beyond. Introduction to the New MACRA/MIPS for Medicaid Providers Wednesday, November 2, 2016 12pm CT REGISTER NOW Please join us for a webinar with Liz LeBreton, Health IT Specialist at the Centers for Medicare and Medicaid Services. She will provide an overview of the final rule, with a special focus on the Advancing Care Information section (formerly Meaningful Use) and implications for Medicaid providers. MIPS applies to physicians and clinicians providing services under Medicare Part B. MIPS does not replace the Medicaid EHR Incentive Program, which will continue through program year 2021. On October 14, 2016, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system. About the Speaker Liz LeBreton is a Health IT Specialist at the Centers for Medicare and Medicaid Services (CMS) on the Medicaid HITECH team. Liz joined CMS in 2012 and is based in the Chicago office. In her current role, Liz provides subject matter expertise on the Medicaid Electronic Health Records Incentive Program, program integrity, policy, and operations. She also helps oversee technical assistance efforts with State Medicaid Agencies. Liz began her federal career as a Presidential Management Fellow (PMF) in HHS’s Office of the Assistant Secretary for Health in Chicago. As part of the PMF program, Liz completed a five-month detail at the White House Office of Management and Budget. Prior to federal government Liz worked for the American Academy of Pediatrics. Liz has a Master’s in Public Health from the University of Illinois at Chicago, and a BA in English from Grinnell College in Iowa.

Event: 11-7-2016 Opioids During Pregnancy

CMS Webinar Wednesday, Oct. 26: CMS Finalizes New Medicare Quality Payment Program

The Department of Health and Human Services (HHS) on Oct. 14, finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. The new Quality Payment Program will gradually transform Medicare payments for more than 600,000 clinicians across the country, and is a major step in improving care across the entire health care system.

 

The Centers for Medicare & Medicaid Services (CMS) invites everyone  to join a webinar Wednesday, Oct. 26, from 2-3 p.m. (ET), on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule with comment period. The webinar will provide an overview of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program. Register Now:  Space for this webinar is limited. Register now to secure your spot. After you register, you will receive an email message with a dial-in number and webinar link. Please note, you will not be able to share your participant information because it will be unique to you.

 

Psychiatric Services Provided Within Community Mental Health Centers (CMHCs) -CLARIFICATION

​To:	​Participating Physicians, Advanced Practice Nurses, and Community Mental Health Centers
​Date:	​October 19, 2016
​Re:	​Psychiatric Services Provided Within Community Mental Health Centers (CMHCs) -CLARIFICATION

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The purpose of this notice is to inform participating physicians and Advanced Practice Nurses (APNs) partnering with participating Community Mental Health Centers and billing the Department of Healthcare and Family Services (HFS) that the Department is adding an enhanced payment for certain fee-for-service psychiatric services. Physicians and APNs who render services in a community mental health setting are eligible to receive the enhanced payments for dates of service July 1, 2016 – June 30, 2017. In order to receive the enhanced payments, physicians/APNs must bill the applicable procedure code with the “UB” modifier and designate the community mental health center as the payee. Please note the community mental health center must be listed as a valid payee on the practitioner’s provider file. The updated Practitioner fee schedule includes a tab with the enhanced payment to providers for fee-for-service psychiatric services provided between July 1, 2016 and June 30, 2017.

Resolution for claims with dates of service on or after July 1, 2016 that were submitted and paid, or are pending payment, prior to programming implementation for the add-on payments:

Providers may submit a void & rebill or a replacement claim. The Department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.

Replacement Claims – To replace a single service line or entire claim, enter Claim Frequency “7.” Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.

Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.

1.)   To electronically void a single service line or an entire claim, enter Claim Frequency “8”. Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292 (pdf), instructions for which may be found in Chapter 100, Appendix 6.

2.)   Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.

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

 

Felicia F. Norwood

Director

2016 IAFP Annual Meeting - November 11-12, 2016

Featuring CME, ABFM-KSA workshops, committee meetings, All Member Assembly, Annual Awards Dinner, and the IAFP board of directors meeting. 
Northern Illinois University – Naperville Campus 
1120 E. Diehl Road in Naperville
Location and directions
ONLINE REGISTRATION IS NOW OPEN!
Fees*:  $300 - Active members for the meeting and CME.  
$250 - New Physicians (less than seven years post-residency)
$245 - KSA workshop (does not include ABFM fees)
$50 - Awards dinner (active members, guests, students & residents)
FREE registration - IAFP Resident and Student members
$50 - Non-member students and residents

*Conference cancellation policy: You may cancel without penalty if cancellation request is received up to and including 15 days prior to the start of the conference. Due to financial obligations incurred by the Illinois Academy of Family Physicians no refunds or credits will be issued on cancellation requests received less than 15 days prior to the start of the event.
Resolutions to the 2016 All-Member Assembly
Schedule of Events 
KSA Group Study at Annual Meeting
Local Hotels 
** Please note that there are no IAFP room blocks at any of these hotels.  Try out our member benefit with Hotel Storm to reserve a room at a discounted rate!  Use code MEMBERPERK

IAFP Hosts 2017 AAFP Ten State Conference

February 17-19, 2017 

Hard Rock Hotel Chicago
230 North Michigan Ave
Chicago IL 60601

Room Rate: $105
Room block code: ILAFPTENSTATE
To make reservations using the room block please call 312-334-6767 or use this direct link from hotel to make reservations online
Room block expires on January 26, 2017
Parking: 24-hour valet parking is available at a rate of $50 a night
Only once in a decade does the AAFP Ten State (which is actually more like 13 states) regional meeting come to Illinois. So block off the dates in your calendar now and take advantage of this local opportunity to learn and network with family medicine leaders from across the upper Midwest and east coast.
The IAFP board of directors will hold their spring board meeting at the event, so it’s a great time to engage personally with our state chapter leaders. The other states send their chapter leaders, so you will be networking with the most dynamic family physician leaders from our neighbors, too. The Hard Rock hotel location ensures that they’ll be plenty of opportunities for fun after the learning is done! Don’t miss out on this once in a decade opportunity. Registration is just $200 for IAFP members and Ten State chapters, $300 for other states' members - Register online here.
Conference cancellation policy: You may cancel without penalty if cancellation request is received up to and including 15 days prior to the start of the conference. Due to financial obligations incurred by the Illinois Academy of Family Physicians no refunds or credits will be issued on cancellation requests received less than 15 days prior to the start of the event.

Here are some highlights already on the schedule!

• Friday opening session – Rebecca Costa, Author of the highly-acclaimed The Watchman’s Rattle. Costa is an American sociobiologist whose unique expertise is to spot and explain emerging trends in relationship to human evolution, global markets, and new technologies. 
• Saturday morning opening plenary session – MACRA, Shawn Martin, Senior Vice President of Advocacy, Practice Advancement and Policy for AAFP.
• Luncheon presentation on physician resilience – AAFP resources, Clif Knight, MD, AAFP Senior Vice President of Education
• Session on “Disruptive innovations in primary care” – how telehealth, telemedicine, apps and wearable devices have changed the patient/physician relationship
• Sunday morning’s closing session covers the Future of ABFM diplomats, from Bob Phillips, MD, MSPH, Vice President of Research and Policy, American Board of Family Medicine.

 

 

Clarification Regarding Record Requirements for Therapy Services in Individualized Education Programs (IEPs)

 

​To:	​Participating Local Education Agency Providers
​Date:	​October 18, 2016
​Re:	​Clarification Regarding Record Requirements for Therapy Services in Individualized Education Programs (IEPs)

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This notice provides clarification on the documentation requirements Local Education Agencies (LEAs) must meet when seeking reimbursement for eligible expenditures related to therapy services. 

 

Pursuant to federal regulation (42 CFR 440.110), physical therapy (PT) and occupational therapy (OT) must be prescribed/ordered, in writing, by a physician or other licensed practitioner of the healing arts acting within the scope of his or her practice under state law. The prescription/order for PT and OT must indicate specifications for the therapy services, including the diagnosis. Note that the Physical Therapy Practice Act (225 ILCS 75) and the Occupational Therapy Practice Act (225 ILCS 90) each limit the types of practitioners that can prescribe/order the respective services.

 

LEAs seeking reimbursement for services for individuals with speech and language disorders must obtain a written referral from a physician or other licensed practitioner of the healing arts acting within the scope of his or her practice under state law. The written referral specifies a need by making a recommendation for speech and language services, but the rendering practitioner, not the referring practitioner determines the diagnosis, frequency and duration of services to be provided. 

 

Referrals for speech and language services can be made by a physician or other licensed practitioner of the healing arts acting within the scope of practice. Examples of other licensed practitioners that can refer speech services in the school setting include, but are not limited to, physician assistants, advanced practice nurses, clinical psychologists, speech-language pathologists or individuals with a Professional Educator License (PEL) endorsed in School Psychology or Speech Language Pathology. The referral of services provided in the school setting are subject to provisions of the Health Care Worker and Self-Referral Act (225 ILCS 47/1). 

 

The prescription/order or referral is required prior to services being rendered and must be updated annually. The written prescription/order/referral must be included in the student’s file and be made available to the Department upon request. Neither the attendance sheet from the IEP meeting nor the signed IEP itself satisfies the requirement for a written prescription/order or referral. 

 

Questions regarding this notice may be directed to the School-Based Health Services Program in the Bureau of Program and Policy Coordination at 217-782-3953.

  

Felicia F. Norwood

Director

Handbook for Providers of Practitioners Rendering Medical Services - Reissue

    

              

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​To:	​All Medical Assistance Providers
​Date:	​October 18, 2016
​Re:	​Handbook for Providers of Practitioners Rendering Medical Services - Reissue

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The Department is reissuing the Handbook for Practitioners Rendering Medical Services.  

 

Providers are encouraged to review the handbook in its entirety. This handbook, in conjunction with the Handbook for Providers of Medical Services, Chapter 100, General Policy and Procedures, provides information necessary for providers to receive payment from the Department.

 

 

Felicia F. Norwood

Director

Provider Handbooks

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The intent of Provider handbooks is to furnish Medicaid providers with policies and procedures needed to receive reimbursement for covered services, funded or administered by the Illinois Department of Healthcare and Family Services, which are provided to eligible Illinois Medicaid participants. The handbooks provide detailed descriptions and instructions about covered services as well as billing instructions.

Providers are responsible for compliance with all policy and procedures contained herein.

Chapter 100 contains general policy, procedures and appendices applicable to all participating providers.

Chapter 200 contains specific policy, procedures and appendices applicable to the provision of a specific type of provider or category of service (specialty/subspecialty).

Chapter 300 - Companion Guide  Information contained in Chapter 300 is a supplement to the X12 (5010) or NCPDP (5.1 or 1.1 batch) Implementation Guides. This handbook contains the companion guides for all providers who will be submitting X12 or NCPDP electronic transactions to the department.

Managed Care Manual - This manual contains helpful information regarding the Medicaid managed care program for providers enrolled in Medicaid.

Additional Resources for Providers

TPL Code Directory (pdf)

7th Annual ABC Conference Zip Code vs. Genetic Code: The Social Determinants of Caring for Children and Families with Special Needs

 

Registration now open   When: Friday, November 18, 2016 Where: Moraine Business and Conference Center, Palos Hills, IL                                   About the Conference: Health starts in our homes, schools, workplaces, neighborhoods, and communities.   Increasing attention is being focused on the economic and social conditions that shape the health of individuals and communities. In fact, where a child lives (their zip code) has a far greater impact on their health and well-being than biological influences (their genetic code) alone. Furthermore, environmental factors, such as chronic stress, can actually change how a person's genetic code is expressed. The 7th Annual ABC Conference will deliver valuable information about social determinants of health in order to enable providers across many disciplines to recognize and address these determinants when caring for children and families with special healthcare needs.                                  KEYNOTE PRESENTATIONS BY   Robyn Gabel, Illinois State Representative, 18th District Julie Morita, MD, Commissioner, Chicago Department of Public Health            Continuing Education Available! Continuing Medical Education Illinois Early Intervention Credits Illinois Education Association Illinois Occupational Therapist Continuing Education Units Gateways to Opportunity Licensed Clinical Social Work Continuing Education Medical Assistant Continuing Education Units Registered Nurse Continuing Education Pre-Approved Sponsor Register Today! Learn more about available sessions and other general informati

PROPOSED CHANGES IN METHODS AND STANDARDS FOR ESTABLISHING MEDICAL ASSISTANCE PAYMENT RATES STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES CLARIFICATION
 




This notice provides additional information and clarification to the original public notice issued on June 30, 2016. The Illinois Department of Healthcare and Family Services (HFS) is proposing a change in the methods and standards by which the Department will reimburse providers. The proposed change is effective for dates of service on or after July 1, 2016 through June 30, 2017 and is addressed below.

As an ongoing effort to provide access to care and quality services, the Department is proposing to increase reimbursement rates for specific psychiatric and behavioral health services rendered by a physician, advanced practice nurse or a licensed community mental health center. These services include but are not limited to mental health assessment, psychological evaluations, medication management, psychotherapy, and counseling.

The reimbursement changes will apply to mental health rehabilitative services provided in or by community mental health centers as well as the physician benefit categories. These proposed changes will increase expenditures by approximately $27.5 million based on current utilization patterns. $25,650,000 applies to the mental health rehabilitative services benefit category and $1,350,000 applies to the physician benefit category.

The proposed change is subject to approval by the federal Centers for Medicare and Medicaid Services and may be modified or revised during the approval process.
The original notice and this clarification may be viewed at the DHS local offices (except in Cook County). In Cook County, the notice and clarification may be reviewed at the Office of the Director, Illinois Department of Healthcare and Family Services, 401 South Clinton Street, 1st Floor, Chicago, Illinois. Comments received regarding this notice shall be published on the HFS web site at http://www.illinois.gov/hfs/info/legal/PublicNotices/Pages/.

This notice is being provided in accordance with federal requirements found at 42 CFR 447.205.

MACRA - Quality Payment Program Begins Soon

MACRA - Quality Payment Program Begins Soon

MACRA - the Medicare Access & CHIP Reauthorization Act of 2015 - is set to transform the way the federal government delivers and pays for healthcare. MACRA replaces the sustainable growth rate (SGR) Medicare Part B reimbursement model with a value-based payment system designed to lower costs and improve healthcare quality. MACRA will replace PQRS, value-based modifier (VBM) and meaningful use with two payment tracks:  

• Merit Based Incentive Payment System (MIPS)
• Alternative Payment Models (APMs)

To assist practices with these changes, Quality Payment Program (QPP) Resource Centers will be established as early as November 2016 to answer questions and provide direct technical assistance and support at no cost to practices with 15 or fewer clinicians. If you would like to be notified of the QPP Resource Center serving your practice, CLICK HERE.  For additional information, visit ILHITREC's  MACRA website or Telligen's MACRA website.

Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines

Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines

​To:	​Physicians, Advanced Practice Nurses, Local Health Departments, School-Based Linked Health Centers, Local Education Agencies (LEAs), and Medi-Check Clinics
​Date:	​October 14, 2016
​Re:	​Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines

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This notice provides information regarding the Vaccines for Children (VFC) program. In an effort to ensure Title XXI (21) and State-Funded All Kids eligible children have access to vaccines, the Illinois Department of Public Health (IDPH) is providing Illinois VFC providers the opportunity to order vaccines (317-funded vaccines) through November 26, 2016 or as long as federal funding remains available. Please see IDPH’s notice dated September 30, 2016 for details.

 

Billing instructions for the transition period are detailed below: 

• For vaccines obtained from IDPH through the limited 317 fund supply, providers must charge HFS $6.40 for each vaccine-specific procedure code.  Reimbursement will be at the ‘Unit Price” rate found on the Practitioner Fee Schedule. 
• For private stock vaccines, providers should charge HFS their usual and customary charge amount for each vaccine-specific procedure code.  Reimbursement will be at the lesser of the provider charge amount or the ‘State Max’ rate found on the Practitioner Fee Schedule. 

For participants enrolled in one of the Medicaid Managed Care Organizations, providers should contact the individual plan for billing policies and procedures, as well as reimbursement information.
Providers must maintain appropriate documentation in their records to be able to provide in the event of an audit.
 
Additional information specific to the VFC program changes are located on the Non-Institutional Providers webpage.
Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood
Director

Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines -Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs)

                 

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Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines

​To:	​Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and Encounter Rate Clinics (ERCs)
​Date:	​October 14, 2016
​Re:	​Vaccines for Children (VFC) Program Transition – Billing 317-Funded Vaccines

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This notice provides information regarding the Vaccines for Children (VFC) program. In an effort to ensure Title XXI (21) and State-Funded All Kids eligible children have access to vaccines, the Illinois Department of Public Health (IDPH) is providing Illinois VFC providers the opportunity to order vaccines (317-funded vaccines) through November 26, 2016 or as long as federal funding remains available. Please see IDPH’s notice dated September 30, 2016 for details.

 

Billing instructions for the transition period are detailed below:

• For vaccines obtained from IDPH through the limited 317 fund supply, clinics must bill the vaccine-specific procedure code as part of a billable encounter (T1015) or as part of a wellness encounter (S5190).
• For private stock vaccines, clinics should bill in accordance with the Vaccination Billing Instructions for Encounter Rate Clinics Only posted on the Non-Institutional Providers webpage.

For participants enrolled in one of the Medicaid Managed Care Organizations, providers should contact the individual plan for billing policies and procedures, as well as reimbursement information.
Providers must maintain appropriate documentation in their records to be able to provide in the event of an audit.
Additional information specific to the VFC program changes are located on the Non-Institutional Providers webpage.
Questions regarding this notice should be directed to a Medical Assistance Consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx

Felicia F. Norwood
Director

Hepatitis C Treatment

Hepatitis C Treatment

​To:	​All Medical Assistance Providers
​Date:	​September 30, 2016
​Re:	​Hepatitis C Treatment

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The purpose of this notice is to inform providers that the cost of newer, direct-acting antivirals (DAAs) for treatment of Hepatitis C for Medicaid beneficiaries will be covered in earlier stages of the condition (F3) effective with dates of service on or after October 1, 2016.

 

The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force recommend a onetime Hepatitis C Virus antibody test for those born between 1945 and 1965 regardless of risk factors. CDC estimates that a significant majority of those living with Hepatitis C belong to this age group and approximately three-fourths of Hepatitis C related deaths occur in this population. The Illinois Medicaid program allows and pays for Hepatitis C antibody testing when ordered by a physician or other authorized practitioner.

 

The DAAs have resulted in a significant shift in the general approach to treatment of Hepatitis C. These new antivirals are considered to be much more effective in eradicating the virus than previously available therapy. In addition, the treatment is safer, of a shorter duration, and in many cases can be accomplished with oral therapy alone, without Interferon, which is known to have many side-effects. Effective with dates of service on or after October 1, 2016, the Department will begin providing prescription coverage for qualifying patients with a Metavir score of F3 down from F4 previously.  

Hepatitis C drugs require prior authorization to be eligible for reimbursement by Medicaid.  Additional information such as the criteria and the necessary prior authorization request forms can be found on the HFS Criteria and Forms webpage.

 

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

 

Felicia F. Norwood

Director

MACRA - Quality Payment Program Begins Soon

   

 

 

MACRA - the Medicare Access & CHIP Reauthorization Act of 2015 - is set to transform the way the federal government delivers and pays for healthcare. MACRA replaces the sustainable growth rate (SGR) Medicare Part B reimbursement model with a value-based payment system designed to lower costs and improve healthcare quality. MACRA will replace PQRS, value-based modifier (VBM) and meaningful use with two payment tracks:  

• Merit Based Incentive Payment System (MIPS)
• Alternative Payment Models (APMs)

To assist practices with these changes, Quality Payment Program (QPP) Resource Centers will be established as early as November 2016 to answer questions and provide direct technical assistance and support at no cost to practices with 15 or fewer clinicians. If you would like to be notified of the QPP Resource Center serving your practice, CLICK HERE.  For additional information, visit ILHITREC's  MACRA website or Telligen's MACRA website.

 

Service Definition and Reimbursement Guide (SDRG), Reissue

​To:	​All Enrolled Medical Assistance Providers
​Date:	​October 12, 2016
​Re:	​Service Definition and Reimbursement Guide (SDRG), Reissue

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The Department is reissuing the Service Definition and Reimbursement Guide (SDRG).

Providers are encouraged to review the handbook in its entirety. This handbook provides information necessary for providers to receive payment from the Department.

Any questions may be directed to the Department at: HFS.CBH@illinois.gov, using the subject line “SDRG” or by calling 217-557-1000.

 

Felicia F. Norwood

Director

Psychiatric Services Provided Within Community Mental Health Centers (CMHCs)

​To:	​Participating Physicians, Participating Community Mental Health Centers
​Date:	​October 13, 2016
​Re:	​Psychiatric Services Provided Within Community Mental Health Centers (CMHCs)

   

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The purpose of this notice is to inform participating physicians partnering with participating Community Mental Health Centers and billing the Department of Healthcare and Family Services (HFS) that the Department is adding an enhanced payment for certain fee-for-service psychiatric services.Physicians who render services in a community mental health setting are eligible to receive the enhanced payments for dates of service July 1, 2016 – June 30, 2017. In order to receive the enhanced payments, physicians must bill the applicable procedure code with the “UB” modifier and designate the community mental health center as the payee.Please note the community mental health center must be listed as a valid payee on the physician’s provider file.

The updated Practitioner fee schedule includes a tab with the enhanced payment to providers for fee-for-service psychiatric services provided between July 1, 2016 and June 30, 2017.

Resolution for claims with dates of service on or after July 1, 2016 that were submitted and paid, or are pending payment, prior to programming implementation for the add-on payments:

Providers may submit a void & rebill or a replacement claim. The Department will accept electronic transactions submitted through MEDI or via 837P files to void or replace a payable or pending-payable claim if submitted within 12 months from the original paid voucher date.

Replacement Claims – To replace a single service line or entire claim, enter Claim Frequency “7.” Detailed instructions on how to replace a claim electronically can be found in the Chapter 300, 837P Companion Guide. This method is preferred as it requires no manual override.

Void & Re-bill – This process involves two steps. The void portion may be completed electronically or on paper. Please refer only to step #1 for a void with no re-bill.

 

1.)   To electronically void a single service line or an entire claim, enter Claim Frequency “8”. Detailed instructions on how to void a claim electronically can be found in the Chapter 300, 837P Companion Guide. A paper void may be completed by submitting a NIPS Adjustment Form HFS 2292 (pdf), instructions for which may be found in Chapter 100, Appendix 6.

 

2.)   Following completion of the void, a new original claim must be submitted within 90 days of the void DCN and may require manual override. If manual override is required, attach to a paper claim: a cover letter stating the reason for request for timely filing override.

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

 

Felicia F. Norwood

Director