BCCHPSM Instructions to Hospital Providers Regarding Recent HFS Notice: Hospital Inpatient Payment for Long-Acting Injectable Antipsychotic Drugs per Public Act 102-0043

November 17, 2023

Blue Cross and Blue Shield of Illinois is working on system updates to align with the Illinois Department of Healthcare and Family Services’ new billing guidance for add-on payments applicable to psychiatric inpatient claims for certain long-acting injectable (LAI) antipsychotic drugs effective with dates of service beginning Jan.1, 2022.

This guidance pertains to psychiatric inpatient claims submitted for Blue Cross Community Health PlansSM members. BCBSIL is asking that providers do not hold claims until our system configuration is complete. BCBSIL will adjust any claims received and billed in accordance with the HFS guidance to include the add-on payments.

When coding LAI - Antipsychotics on a service line, providers should only use covered revenue codes. Use of non-covered revenue codes will result in a full claim denial. Drug codes presenting on the Practitioner Fee Schedule with “Y” populating in the National Drug Code Indicator column must be submitted with the NDC on the service line.   

Beginning Jan. 1, 2024, BCBSIL will require providers to submit prior authorization requests for LAI antipsychotic drugs concurrently with requests for inpatient behavioral health care services. Prior authorization requests can be submitted electronically or by phone.   

Instructions for retroactive add-on payments for dates of service back to Jan. 1, 2022:
If providers wish to file corrected claims to reflect the allowable codes published by HFS to bill for the LAI, there must be a valid inpatient authorization on file. Providers will have 90 days from the date of this News and Updates notice to resubmit corrected claims. After receipt of all corrected claims, BCBSIL will identify and adjust claims allowing a one-time override of timely filing and apply the add-on payment. Only claims that have been initially received per timely filing requirements will be eligible for adjustment. 

Providers do not need to request prior authorizations from the BCBSIL Utilization Management Department for injections provided prior to Jan. 1, 2024. It is expected that providers are following criteria as identified in 89 Ill. Admin. Code section 148.110 when administering LAI drugs.