Medicaid

This is an option for patients who have waited over 45 days since Medicaid enrollment submission without a determination. Assisters can help a patient request a temporary Medicaid card.

HFS subcontracted to provide client enrollment services which are available via through the website and phone support. The website is a portal for client managed care materials and information. It includes interactive search and listing of available providers by geography or provider name, enrollment materials, and client benefit and plan comparison searches.

Notices contain pertinent information for providers regarding covered services and reimbursement policies. HFS no longer mails paper copies of notices and bulletins so you must register for email notifications.  When registering for the provider specific categories, providers should also enroll for the “All Medical Assistance Providers” category to ensure notification of all applicable information.

The HFS handbooks include Chapter D-200 which has details specific to encounter rate clinic (FQHC) policies and procedures. Chapter 200 includes the handbook for all services by provider type or service (i.e. Healthy Kids, School-based Health Centers, etc). Chapter 100 is the general handbook of policies and procedures. Of special note are Appendix 5 which includes error codes and Appendix 12 which contains the Medicaid co-pay schedule.

This Managed Care Manual gives background and resources for providers enrolled in Medicaid but does not supersede, modify or replace provider contracts with the individual MCOs.

Dental policies like eligibility, prior authorization, claim submission, provider enrollment, school-based programs, and clinical criteria by age category is included in the Dental Office Reference Manual. Of particular interest is the Appendix A-C that list covered benefits for children and adults. 

Resources for the cost report include instructions and the spreadsheet template. The report is required to be filed with the HFS Bureau of Health Finance no later than 180 days after the end of your fiscal year. The completed FQHC Modified Form 242 and the Certified Financial Statement prepared by an independent Certified Public Accountant must be filed for compliance.

A summary of the Illinois program and current program links can be found on the website. 

IPHCA staff is able to assist members with questions regarding HFS including enrollment, billing, payment analysis, Medicaid Cost Reporting, and programs such as Illinois Health Connect, Dentaquest and MCO opportunities, etc. Contact Cheri Hoots Tabor at  choots@iphca.org.