February 14, 2017
New HFS MCO Provider Complaint Portal
The Department of Healthcare and Family Services (HFS) has launched a secure electronic web-based portal to assist providers statewide in resolving issues with Illinois Medicaid Managed Care Organizations (MCOs): HFS Managed Care Provider Complaints webpage.
HFS recognizes the importance of providers having a mechanism for reporting and resolving issues encountered with an individual Medicaid MCO when these issues cannot be resolved using existing processes designated by the MCO.
A major goal of the new MCO provider complaint portal is to facilitate prompt and fair resolution of disputes between MCOs and providers. Issues impacting immediate access to care will be expedited.
The new MCO provider complaint portal does not replace issue reporting and escalation processes already in place between providers and an MCO. Prior to submitting a complaint through the new online portal, issues must already have been submitted to and reviewed by the MCO in question. If HFS determines a complaint was submitted prior to the MCO being afforded an opportunity to resolve it directly with the provider, the complaint will be immediately closed.
Please note that this new system is designed specifically for issues enrolled providers have with Illinois Medicaid MCOs. Provider complaints regarding the resolution of Medicaid fee-for-service issues should continue to be directed to HFS at 877-782-5565.
Hospital Cost Report Forms and Instructions
HFS issued a notice informing providers that the Medicaid hospital cost report forms and instructions are available on the its Cost Report webpage. The Medicaid hospital cost report and related Medicare cost report are due within five months after the close of the hospital’s fiscal year. HFS will not grant an extension of the Medicaid hospital cost report due date unless the Centers for Medicare & Medicaid Services (CMS) grants an extension of the due date for the related Medicare cost report. Should CMS extend the Medicare cost report due date, HFS will extend the Medicaid cost report due date by an equivalent period of time. See the notice for more specific details.
New Web-Based Medical Record Submission Process for Retrospective Pre-Payment and Post-Payment Utilization Review Effective with Dates of Notice Beginning April 11, 2017
HFS, in conjunction with its Quality Improvement Organization, eQHealth Solutions, Inc., announces a new web-based medical record submission process for retrospective pre-payment and post-payment reviews. This new process will be effective with eQHealth’s Notice of Selection of Medical Records for Offsite Review beginning with Date of Notice April 11, 2017.
The transition to a web-based submission process will benefit providers by eliminating the expense of photocopying and mailing hard-copy medical records, as well as reducing the risk of HIPAA non-compliance. Please refer to the notice for details.
Pharmacy Benefits Management System (PBMS) Registration for Pharmacy Pilot Testing
HFS issued a notice regarding registration information for pharmacies to participate in pilot testing of its new Point of Sale Pharmacy Benefits Management System (PBMS). To participate in pilot testing, pharmacies must provide the information listed in the notice on or before February 17, 2017, via email at PBA_POSTechSupport@changehealthcare.com or via fax at 877-853-8533.
Changes to Current Procedural Terminology (CPT) Codes Used for Separate Reimbursement of Risk Assessments
HFS issued a notice to provide guidance regarding Current Procedural Terminology (CPT) coding changes for risk assessments. The notice outlines the CPT coding changes. These CPT coding changes are effective with dates of service on or after January 1, 2017.
Statewide Transition Plan
HFS has updated the Statewide Transition Plan webpage to include a Revised Statewide Transition Plan.
HFS has posted the calculations and amounts for hospital ACA Access Payments for February 2017 through April 2017.
Practitioner Fee Schedule
HFS has posted an update to the Practitioners Fee Schedule.