IlliniCare Health Plan offers our participating providers the advantage of our easy-to-use secure provider portal. The secure provider portal offers many of the same features available through our provider services phone number without the need to make a phone call – no waiting and no on-hold music. On our secure provider portal you can:

• Easily check patient eligibility
• View, manage, and download your patient list
• View, submit, copy, and correct claims
• Submit batch claims
• Check claim status (paid, pending, denied)
• View and submit service authorizations
• Communicate with us through secure messaging
• Maintain multiple providers on one account
• Control website access for your office
• View historical patient health records
• Submit assessments to provide better patient care
• View member gaps in care

The secure portal not only provides you with tools to submit claims and check eligibility, but you can also:

• Save money. There’s no need to purchase claim forms, expensive software and postage to submit paper claims.
• Receive payment faster. Clean claims submitted online process faster, meaning you are reimbursed more quickly.
• Click here to sign up for the online secure portal. To register, all you need is your Tax ID, name and email address.

Reminder – Do Not Submit Handwritten Claim Forms
IlliniCare is reminding providers that paper claim forms submitted handwritten, or as copies of an original claim form will NOT be accepted, and the claim will be denied. IlliniCare only accepts claim forms printed in Flint OCR Red, J6983, (or exact match) ink. Although a copy of the CMS-1500 of UB-04 form can be downloaded, copies of the form cannot be used for submission of claims, since your copy may not accurately replicate the scale and OCR color of the form.

The majority of paper claims sent to carriers and DMERCs are scanned using Optical Character Recognition (OCR) technology. This scanning technology allows for the data contents contained on the form to be read while the actual form fields, headings, and lines remain invisible to the scanner. Photocopies cannot be scanned and therefore are not accepted.

Any claim that is handwritten or submitted on a black and white claim form will be automatically denied.

Provider Services – we’re here to help!
Remember, our provider services department is here to answer your questions. Contact us Monday – Friday, 8:00 am – 5:00 pm CT at (866) 329-4701.

Medical Claims – 68069

Behavioral Claims – 68068

If you submit a claim that includes the old payer ID numbers (68066 for medical and 68065 for behavioral claims), these claims will continue to process for 90 days. After this 90 day period, the old payer ID numbers will no longer work and your claim will not process. Please note, there has been no change to the payer ID numbers of our other clearinghouses which include SSI, Gateway EDI, Smart Data Solutions and Availity.

If you have any questions, please contact Provider Services at (866) 329-4701. For more information regarding submitting your claims electronically, please click here.

These benefit changes included charging IlliniCare members copays for their prescriptions. Upon reevaluation of the pharmacy benefit, IlliniCare has decided not to implement this change. IlliniCare members will not be charged copays for any prescriptions. Members will continue to receive their medications with no out-of-pocket cost as an added benefit. IlliniCare understands the importance of medication adherence, and wants to ensure our members are provided with the medication they need to stay healthy.

As a reminder, here is a list of the benefits that will be changing effective April 1, 2013:

If you have any questions regarding the changes IlliniCare is implementing as a result of the SMART Act, please contact Provider Services at (866) 329-4701. Thank you for being a valued IlliniCare provider.

One of these changes included copays for your prescriptions. However, we have decided to not change this benefit. You will not be charged for any copays for your prescriptions or medical services.

IlliniCare is dedicated to ensuring you receive quality care and stay healthy. Receiving the medication you need is a vital part of your health. As an added benefit of being a member of IlliniCare Health Plan, you will continue to receive your prescriptions without any additional cost to you.

As a reminder, here is a list of the benefits that will be changing April 1, 2013:

• Podiatry care from any foot doctor is covered only for adults if they have diabetes or a circulatory condition.
• Payment for glasses is limited to one pair every two years. You can still see the eye doctor for an exam every year. IlliniCare’s enhanced vision benefit is still in effect. This means you have more choices in frame selection. You also have a choice to receive contacts instead of glasses.
• Group psychotherapy for residents of nursing homes is no longer covered. This also includes transportation to and from group psychotherapy.
• There will be a limit on therapies including adult speech, hearing and language therapy, physical therapy and occupational therapy. This will be limited to 20 visits for each type of therapy per year.
• In order for you to qualify for bariatric surgery, you must be part of a weight loss program under supervision of your primary care physician (PCP) for at least six months.

There were certain changes that the Illinois Department of Healthcare and Family Services made to Medicaid benefits that IlliniCare is not changing. These are added benefits you will continue to receive by remaining a member of IlliniCare. These include:

• There will be NO copays for medical services, including prescriptions and medical visits.
• You will still be able to receive an annual dental visit. This includes practice visits if you have a developmental disability or a serious mental illness.
• Chiropractic services will still be available for adults. This is limited to manipulation for subluxation of the spine. Prior authorization from your doctor will still be required after 12 visits per year.

IlliniCare is dedicated to ensuring you receive the best health care. If you have any questions or concerns about the changes to your benefits, please contact us. Contact Member Services at (866) 329-4701. If you are hearing impaired, please contact our TDD/TTY line at (866) 811-2452.

These changes include reimbursement reductions, limitations on services, reductions in services and prior authorization changes. Please note that beginning March 1, 2013, IlliniCare began reimbursing according to the HFS fee schedule. Below, please find a grid that outlines the changes that were made effective for IlliniCare participating providers:

If you have any questions regarding the changes IlliniCare is implementing as a result of the SMART Act, please contact Provider Services at (866) 329-4701. Thank you for being a valued IlliniCare provider.

*This blog entry was updated on 3/27/13. The original post explained IlliniCare would charge copays for prescriptions beginning April 1, 2013. However, IlliniCare has decided to not implement this change. Members can continue to receive prescriptions at no cost to them, including over-the-counter medication with a prescription from his/her doctor. This will be an added benefit for IlliniCare members.

• 12: Admission Date
• 13: Admission Hour
• 14: Admission Type
• 15: Admission Source
• 16: Discharge Hour
• 17: Status

If you have any questions, please contact IlliniCare’s Provider Services at (866) 329-4701. Thank you for being a valued IlliniCare provider.

IlliniCare Health Plan (IlliniCare) is making certain changes to our benefits as a result of the SMART Act. These changes will begin as of April 1^st, 2013. These changes include:

• Podiatry care from any foot doctor is covered only for adults if they have diabetes or a circulatory condition.
• Payment for eyeglasses is limited to one pair every two years. You can still see the eye doctor for an exam every year. IlliniCare’s enhanced vision benefit is still in effect. This means you have more choices in frame selection and have a choice to receive contacts instead of eyeglasses.  Click here for more information about this enhanced benefit.
• Group psychotherapy for residents of nursing homes is no longer covered. This also includes transportation to and from group psychotherapy.
• There will be a limit on therapies including adult speech, hearing and language therapy, physical therapy and occupational therapy. This will be limited to a maximum of 20 visits per year.
• In order for you to qualify for bariatric surgery, you must be part of a weight loss program under supervision of your primary care physician (PCP) for at least six months.

There were certain changes that the Illinois Department of Healthcare and Family Services made to Medicaid benefits that IlliniCare is not changing. These are added benefits you will continue to receive by remaining a member of IlliniCare. These include:

• There will be NO copays for prescriptions or medical services, including doctor and clinic visits.
• You will still be able to receive an annual dental visit. This includes practice visits if you have a developmental disability or a serious mental illness.
• Chiropractic services will still be available for adults. This is limited to manipulation for subluxation of the spine. Prior authorization from your doctor will still be required after 12 visits per year.

IlliniCare is dedicated to ensuring you receive the best health care. If you have any questions or concerns about the changes to your benefits, please contact us. Contact Member Services at (866) 329-4701. If you are hearing impaired, please contact our TDD/TTY line at (866) 811-2452.Thank you for being a valued member of IlliniCare.

*This blog entry was updated on 3/29/2013. The original post explained IlliniCare would charge copays for prescriptions beginning April 1, 2013. However, this is no longer occurring. For more information, click here.

Do’s

• Do use the correct P.O. Box number
• Do submit all claims in a 9” x 12” or larger envelope
• Do type all fields completely and correctly
• Do use typed black or blue ink only at 9-point font or larger
• Do include all other insurance information (policy holder, carrier name, ID number and
• address) when applicable
• Do attach the EOP from the primary insurance carrier when applicable
• Note: IlliniCare is able to receive primary insurance carrier EOP [electronically]
• Do submit on a proper original form – CMS 1500 or UB 04

Don’ts

• Don’t submit handwritten claim forms
• Don’t use red ink on claim forms
• Don’t circle any data on claim forms
• Don’t add extraneous information to any claim form field
• Don’t use highlighter on any claim form field
• Don’t submit photocopied claim forms (no black and white claim forms)
• Don’t submit carbon copied claim forms
• Don’t submit claim forms via fax

If you have any questions regarding claims, please contact IlliniCare Provider Services at (866) 329-4701. You can also reference the IlliniCare Provider Manual or the IlliniCare Billing Guide by visiting the Provider Resources page on our website. Thank you for being a valued IlliniCare provider.

You used to get this card every month. With the new medical card, you will only receive it once a year. Make sure to keep your new medical card, do not throw it away!

Below are some common questions about the new medical card.

What is the Medical Card?
The Medical Card is issued once to people who are enrolled for medical benefits. Show the paper card whenever you have a healthcare appointment. No more monthly cards. Keep your new Medical Card! Do not throw this Medical Card away.

How do I use my Medical Card?
Take your Medical Card and a picture ID to any healthcare appointment. Your provider will use it to find out what services you are eligible for. Do not throw your paper Medical Card away. Even if your medical benefits end, keep the Medical Card. You can use it again if you become eligible in the future.

For questions about your medical coverage and/or if you believe a member of your household is eligible for services but did not receive a card, call DHS 1-800-843-6154 or HFS 1-800-226-0768 (TTY 1-877-204-1012).

• If you have a LINK Card, keep it, you will continue to use it for your cash and SNAP benefits.
• If you are a DCFS client call 1-800-228-6533.

What happens if I forget to take the card to my appointment?
If you forget your Medical Card, you can still receive healthcare services. Give your Medical Card number or any two of the following to your provider.

• Name
• Social Security Number
• Date of Birth

To check your eligibility using the 24 hour automated system, call 1-855-828-4995

What if I am in a managed care plan, like IlliniCare Health Plan?
You will receive a new Medical Card and you will receive a separate card from your health plan, IlliniCare. Bring both cards to your appointment. Be sure to stay up to date about your enrollment by reading any information sent to you by IlliniCare. If you have questions about your enrollment in your IlliniCare, contact Member Services at (866) 329-4701 or for the hearing impaired, our TTY line at (866) 811-2452.

What do I do if my Medical Card is lost or stolen?
Call DHS 1-800-843-6154 or HFS 1-800-226-0768 (TTY 1-877-204-1012) to request a replacement card. In the meantime, you still can receive healthcare services. Always take your picture ID with you. There is no charge for a replacement card. Your replacement Medical Card will be mailed to you.

Important Reminder
Be sure to keep your caseworker up to date about any changes, such as address or current phone number. It is important that your caseworker and your healthcare provider have the most current information.

Front of Medical Card

The Medical Card contains the name; the Medical Card ID number and the date of birth for each who is enrolled. Always keep this card in a safe place and never allow someone else to use the card.

Back of Medical Card

Effective March 1, 2013 IlliniCare Health Plan will update its Medicaid Fee Schedules to be consistent with the current Medicaid rates established by Illinois’ Department of Health and Family Services. Please click here to see the current Medicaid Fee Schedule.

If any additional changes are made to rates, prior authorization requirements and/or benefit limitations, IlliniCare will provide additional information. If you have any questions, please contact IlliniCare Provider Services at (866) 329-4701.