IlliniCare Health Plan - Quick Billing Guide

Transcription

1 IlliniCare Health Plan - Quick Billing Guide This guide explains how to submit a claim online using IlliniCare Health Plan s (IlliniCare) secure provider portal, as well as examples of paper claims. This guide should be used by supportive living facilities. In order to submit claims online, you must create an account. To access IlliniCare s secure provider portal, visit Step 1: Click Claims on the top navigation bar. Step 2: Click Create Claim. Step 3: Enter the member s ID Number or their last name, and their birth date. Click find. Step 4: You will then be prompted to choose a claim type. Choose CMS 1500, Professional Claim. Step 5: Enter in the Patient s Account Number. This would be the number you associate with this member s record in your system. Step 6: Enter in prior authorization number. This information will be provided to you by our Integrated Care Team. Step 7: Enter in the diagnosis code. This will be provided to you by our Integrated Care Team. Step 8: Click Next.

2 Step 9: Enter in the dates of service. Step 10: Enter in the place of service; for SLFs, enter in 13 - Assisted Living. Step 11: Enter in procedure code T2033. If entering in a temporary absence, enter in procedure code T2033 with the modifier U1. Step 12: Place a check mark next to the diagnosis code. Step 13: Enter in the TOTAL charges for this service, as well as the number of days. Step 14: Select Save/Update. This will add this service line to your claim. If you have additional services to include for this specific member, repeat steps Questions? Contact us! Provider Services: (866) Step 15: Once you have completed adding service lines to this claim, click Next.

3 Step 16: Search for rendering provider information using your Tax ID Number. Choose the correct provider, and it will appear under Selected Provider. Step 17: If the billing provider and service facility location are the same as the rendering provider, select that option to fill in the relevant information. If not, enter in the information for the billing provider and service facility location. Step 18: Click Next. Final Steps: 19. Upload any necessary attachments. 20. Review your claim to ensure it is correct. 21. Press submit! Questions? Contact us! Provider Services: (866)

4 CMS 1500 Form Billing Instructions The instructions below explain the fields required on a CMS 1500 form for Supportive Living Facilities. Item Field Description/Instructions Required? 1 Required Indicate the type of health insurance for which the claim is being submitted. For members of the Integrated Care Program, check Medicaid. 1a Required Enter the member s Medicaid ID number in this field. 2 Required Enter in the member s full name. Enter last name, first name and middle initial. 3 Required Enter in the member s date of birth and sex. For the date of birth, follow this format: MMDDYYYY. Check the appropriate box indicating the member s gender. 5 Optional Enter in the member s address. This information is not used in claim s processing, but can be entered if desired. 6 Required Checkmark self. 21 Required Enter in diagnosis code of member. If you have a diagnosis code available, you can use the code you have for that member. If you do not have the diagnosis code, the Integrated Care Team can provide it for you. 23 Optional Enter in the prior authorization number. All Supportive Living Facility stays require prior authorization. When services are setup for a member, the Integrated Care Team will provide this number to you. 24A-G Introduction Section 24: This section is comprised of six service lines. The six service lines have been divided horizontally. A valid claim must have at least one completed service line. The instructions for each field on the service line (24A-G) apply to all six lines. 24A Required Enter in the dates of service. A from date of service must be entered. If a to date of service is not entered, the from date of service will be used as the to date of service as well. All dates must be entered in the MMDDYYYY format. All dates of service must have occurred after the date the claim is submitted. 24B Required A two-digit place of service is required; for SLFs, enter in 13: Assisted Living. 24D Required Enter in the appropriate procedure/service code. For SLFs, this will be T E Required Enter 1 in this field. This points to the diagnosis code you placed in field 21. Diagnosis codes will be provided by the Integrated Care Team. 24F Required Enter in the total charges for the service. Enter in the dollars to the left of the dashed line and cents to the right of the dashed line. Services with no charges will be denied. 24G Required Enter in the amount of units of service being billed as appropriate. For SLFs, units are days. 25 Required Enter in provider Tax ID Number. Also check the box to determine which type of Tax ID Number is being used. 26 Optional This is your reference number for the member. This is an optional field. 27 Required Check mark Yes. 28 Required Enter in the total of all service line charges. The total charge amount MUST equal the same of all service line charges. 31 Required A signature and date are required. The signature can be an original signature, a stamped signature, a typewritten signature, or a printed signature, but it MUST be the name of a person. It cannot be signature on file or the name of a facility. Enter date in MMDDYYYY format. 32 Required Enter in the service location name and address. 33 Required Enter in the billing provider s name, address and phone number in this field.

5 CMS 1500 Form Billing Instructions - Continued The next page shows a blank CMS 1500 form, so you can see where the fields described in these instructions are on the form. After that page, please find an example claim form. This includes dummy fields to show a properly filled out form. Billing Dos Submit your claim within 90 days of the date of service Submit on a proper original form CMS 1500 Mail to the correct PO Box number Submit all claims in a 9 x 12 or larger envelope Type all fields completely and correctly Use typed black or blue ink only at 9-point font or larger Include all other insurance information (policy holder, carrier name, ID number and address) when applicable Billing Don ts Submit handwritten claims Use red ink on claim forms Don t circle data on claim forms Don t add extraneous information to any claim form field Don t use highlighter on any claim for 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 Questions? Contact us! Provider Services: (866)

6

7 EAMPLE PAPER CLAIM Member, Joseph, M W. Illinois Street SAME Westmont SAME IL SIGNATURE ON FILE SIGNATURE ON FILE T T James Provider U1 Supportive Living Facility, Inc 1000 W. Oakdale Ave Orland Park IL Supportive Living Facility, Inc 1000 W. Oakdale Ave Orland Park IL 60462