Illinois Medicaid Claims Alert: Hospice Room and Board Adjustments and Repayment

October 11, 2022

Attention Hospice Providers: On Aug. 29, 2022, the Illinois Department of Healthcare and Family Services (HFS) issued this provider notice regarding incorrect submission of hospice room and board claims to HFS, as  these claims should be submitted to the appropriate Managed Care Organizations (MCOs) for reimbursement. 

HFS has advised that the incorrect payments have been voided and the incorrect payments have been recovered by HFS as appropriate. As a result of the voided claims and payment reversals, hospice providers will need to work with the appropriate MCOs on claims submission and reimbursements for services rendered. 

In response to the HFS notice, Blue Cross and Blue Shield of Illinois (BCBSIL) will work with hospice providers to resolve claims submission and reimbursement discrepancies, if applicable, for services rendered to Blue Cross Community Health PlansSM (BCCHPSM)  members

For claims originally submitted to and reversed by HFS for our BCCHP members, including Managed Long-Term Services and Supports (MLTSS) members, hospice providers must submit the appropriate claims to BCBSIL as soon as possible. Should claims deny for timely filing, please note that BCBSIL will waive timely filing and adjust claims accordingly. 

If you have any questions or need more information, call Customer Service at 855-653-8126 or email your assigned Provider Network Consultant.