New Billing Guidelines for Home and Community-Based Services (HCBS) Waiver Providers

November 10, 2020

As mentioned in a News and Updates on Oct. 5, 2020, the Illinois Department of Healthcare and Family Services (HFS) has issued billing guidance that will REPLACE any previously issued billing guidance for HCBS Waiver providers for any claims received starting Nov. 1, 2020. Specific guidance can be found on the Illinois Associations of Medicaid Health Plans (IAMHP’s) website . New billing requirements have been developed collaboratively between Blue Cross and Blue Shield of Illinois (BCBSIL) and HFS.

There are five different waiver programs that BCBSIL, and the providers who render these services, may 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 HCBS waiver providers that may bill BCBSIL for waiver services:

These providers must be registered with HFS as a HCBS Waiver Provider in alignment with the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system. The HCBS waiver providers should be considered ‘atypical’ by HFS’ IMPACT system, with no associated National Provider Identifier (NPI). BCBSIL also requires that waiver providers submit their HFS Legacy Provider Number (Medicaid ID) on the claim and that this matches the Medicaid ID associated with the HCBS Waiver Provider’s IMPACT registration. If an NPI is received on a claim for waiver services, then BCBSIL will reject the claim.

CHANGE: For paper claim submission, providers were previously required to submit taxonomy codes in box 33b. With the revised guidance the HFS Medicaid ID should be submitted in this field instead with G2 immediately before the ID with no spaces.

Questions regarding claims or changes may be directed to the following:

Northwest, Cook and Collar Counties

Marian Brown - PNC
Marian_E_Brown@bcbsil.com
312-653-4762

or

Thomas Edwards - PNC
Thomas_Edwards@bcbsil.com
312-653-4423

Downstate

Lisa Kugler – Manager
Lisa_Kugler@bcbsil.com
217-479-6263                                                          

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.  References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.