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This bulletin updates Home and Community-Based Services (HCBS) Waiver providers of new policy and procedure billing changes rendered by HCBS providers.

Date: 09/17/20

This bulletin updates Home and Community-Based Services (HCBS) Waiver providers of new policy and procedure billing changes rendered by HCBS providers.

These new billing policies and procedures will replace any previously issued billing guidance for these providers for any claims received starting 11/1/2020. Providers should continue billing Medicaid Managed Care Organizations (MCOs) with current practices until that time.

As required by the Illinois Department of Healthcare and Family Services (HFS), HCBS Waiver providers are eligible to render covered services but must adhere to the prescribed billing criteria to be reimbursed accordingly by MCOs.

There are five different waiver programs the MCOs administers and for which the providers of service bill for reimbursement:

  • Elderly Waiver;
  • Person with Disabilities Waiver;
  • Persons with HIV or AIDS Waiver;
  • Persons with Brain Injuries (BI) / Traumatic Brain Injury (TBI) Waiver; and
  • Supportive Living Program -SLP Waiver.

Applicable Provider Types:

The following HFS Provider Types are consider HCBS Waiver Providers that can be billed to an MCO:

HFS Provider Type  HFS Description
090 Waiver Service Provider - Elderly (IDoA)
092 Waiver Service Provider - Disability (DHS/DRS)
093 Waiver Service Provider - HIV/AIDS (DHS/DRS)
098 Waiver Service Provider - TBI (DHS/DRS)

 

To file a claim for services that an MCO has approved for one of the five HCBS waivers described above, waiver providers are required to register as a Waiver provider with IMPACT. Many HCBS providers are considered ‘atypical’ by HFS’ IMPACT system.

Please note, MCOs will require that the HFS’ Legacy Provider Number (Medicaid ID) on the claim matches the IMPACT Legacy Provider Number (Medicaid ID). MCOs will not process the claim if the Legacy Provider Number (Medicaid ID) used does not match the corresponding HFS’ Legacy Provider Number (Medicaid ID) and IMPACT-registered categories of service, specialties etc.

Billing Instructions:

Specific guidance can be found on the Illinois Associations of Medicaid Health Plans (IAMHPs’) website (PDF).

Questions: Questions regarding claims or changes may be directed to a billing manager at YouthCare Health Choice Illinois at ILProviderNetwork@Centene.com.