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 has created multiple connection avenues described in a February 2020 Provider Notice available here.

Medicaid has worked to expand managed care to 102 counties in order to deliver integrated and quality managed care to Enrollees, supporting Seniors, Persons with a Disability, Families and Children, Special Needs Children, and adults qualifying for the HFS Medical Program under the Affordable Care Act (ACA Adults). The current HealthChoice program contract launched in January of 2018. HFS also has a Medicare Medicaid Alignment Initiative MCO program for dual eligible.

The HFS Care Coordination Webpage features the following resources:

Medicaid Managed Care Program Map of the state

Total Care Coordination Enrollment for all Programs (HealthChoice, MMAI)

Affordable Care Act Enrollment

The following are active versions of the model contracts between the state and MCO:

HFS MCO model contract for 2018 Furnishing Health Services by an Organization

HFS MCO model contract for Medicare Medicaid Alignment Initiative (MMAI)

HFS subcontracted to provide client enrollment services which are available via the Enroll HFS 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.

As of August 2015 Medicaid provider enrollment is managed through an online system called IMPACT. IMPACT software users must first register themselves to obtain a single sign-on. Directions are available here. Registering as a Medicaid rendering provider in Illinois requires the provider have several pieces of information ready, detailed here, before beginning the online enrollment process. If you are enrolling for the first time as an FQHC or adding a new site to an existing FQHC please contact sgaines@www.iphca.org for tips specific to FQHCs.

The Illinois Department of Healthcare and Family Services will be using IMPACT information as a new way to credential providers during the Medicaid provider enrollment and update process. There’s a new question on the enrollment checklist about liability insurance and policy coverage limit insurance. The Bureau of Primary Health Care suggests you respond with the following:

Name of Insurer:

Health Resources and Service Administration (HRSA)

5600 Fishers Lane, Rockville, MD 20852

Coverage Amount:

No Cap

Within the coming years, there will be numerous changes in the Medicaid and All Kids Programs as a result of Medicaid reform and national health care reform. If you would like to receive updates and information from HFS about these changes or any other program information, register online.

These 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 Notification in order to receive the information. 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.

Illinois Association of Medicaid Health Plans MCO Provider Handbook as approved by HFS for HealthChoice Medicaid plan provider. Click Here 

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. 

Exhibit A: Benefits covered for children under the age of 21 Diagnostic Services 

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 is available here.

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 Susan Gaines at (217) 541-7409 or sgaines@www.iphca.org.