News - Illinois Medicaid NIPS Billing Update

Effective July 1, 2020 Illinois Medicaid transitions Non-Institutional Provided Services (NIPS) to be billed on institutional claims.

On June 2, 2020, the Illinois Department of Healthcare and Family Services (HFS) made the following announcement:

“all out patient services billed on a professional claim (HFS 2360/837P) to HFS’ Non-Institutional Provided Services (NIPS) and paid under the Practitioner Fee Schedule will be billed on an institutional claim (UB-04/837I)…”

You can access the HFS Provider Notice here.

This change is good news in the long run, as it will greatly simplify the process of billing Illinois Medicaid outpatient services. Our team of experts at efficientC and OS, Inc. are on top of this change and will be ready so that on July 1st, 2020 you can be confident your Illinois Medicaid claims will go out correctly.

These are big changes for the payers to implement for both claims processing and reimbursement, so our team will be monitoring claims and denials throughout the transition period. We encourage all efficientC customers to monitor their Insights Payer Scorecards regularly for changes in MCO reimbursement and denials in the coming months.

Below is a summary of the changes from the Illinois Health & Hospital Association - PFS Communications email we received.

The full IHA Memorandum can be found here.

Summary of Changes

Below please find a summary of the Provider Notice, as well as some additional details HFS has shared with IHA.

• An Ambulatory Procedures Listing (APL) code will no longer be required on the UB-04/837I;
• Long Acting Reversible Contraception (LARC) performed in the inpatient setting, following delivery, will be billed on the UB-04/837I, but an add-on payment to the EAPG rate will be made;
• Hospitals will no longer need a separate fee-for-service (FFS) provider ID for “From” dates of service on or after July 1, 2020;
• Beginning July 1, 2020, hospitals must bill all outpatient services under the NPI assigned for institutional services;
• Claims requiring an attachment or manual override bill must continue to be billed on the UB-04 paper claim form to the Hospital Unit; and
• The MCOs are scheduled to convert outpatient services currently billed on the CMS-1500/837P to the UB-04/837I on July 1; however, implementation for the MCOs may be slightly delayed.