No images? Click here
March 2025
IPHA Third-Party Billing Forums – Coming Soon to a Location Near You
During the month of April, IPHA will host three (3) regional meetings to provide information about billing and revenue cycle management (RCM) resources available to health departments and community-based organizations. We would like to thank the Illinois Association of Medicaid Health Plans (IAMHP) and all the Medicaid managed care organizations (MCOs) for arranging to have representatives from each MCO attend the forums. These forums will provide valuable opportunities for public health providers to meet, network, and become better acquainted with key personnel from each of the MCOs.
Each forum will begin with a discussion of billing best practices and strategies to maximize revenue from third-party billing. Representatives from each MCO will provide information about resources and services available to their contracted providers. This will be followed by a panel discussion of current issues impacting public health departments and community-based organizations. Each forum will end with an update about the funding provided by Illinois Department of Public Health (IDPH) to help public health departments and community-based organizations implement an electronic health record that is fully integrated with billing and RCM services.
Please register to attend the Third-Party Billing Forum in your region:
- Central Illinois – April 3, 9:00 AM – 1:30 PM, at the Peoria City/County Health Department, 2116 N. Sheridan Road, Peoria, IL
- Southern Illinois – April 9, 10:00 AM – 2:00 PM, at the Rolland Community Building, 800 S. 27th Street, Mt. Vernon, IL (This meeting will be held in conjunction with Southern IL Public Health Consortium’s Bookkeepers’ meeting)
- Northern Illinois – April 17, 9:00 AM – 1:30 PM, at the Will County Health Department and Community Center, 501 Ella Avenue, Joliet IL
Funds Available for Implementation of an Electronic Health Record (EHR) with Billing Services
IPHA has been awarded a contract by Illinois Department of Public Health (IDPH) to help local health departments (LHDs), community-based organizations (CBOs), and other healthcare providers build and enhance their capacity to bill Medicaid, Medicare, and private insurance. The goal of this project is to develop, or enhance, third-party billing capacity through infrastructure development and technical assistance.
One of the primary objectives of this project is to expand the use of Electronic Health Records (EHR) by LHDs and CBOs. To help achieve this, project funds are available to qualified health care providers for the implementation of an EHR with a comprehensive billing and RCM program. These funds will cover most, if not all, of the costs associated with implementation and training for most organizations.
This is an extraordinary opportunity for providers that do not currently have an EHR. To qualify for the funding, all health care providers funded by this project must provide and bill for HIV and/or STI services. If your organization does not currently provide or bill for HIV and/or STI services, you may still qualify. IPHA’s HIV/STI prevention staff will provide guidance and assistance to help you implement these services at your facility.
To learn more about this program and to find out if your organization qualifies for funding, please contact Third-Party Billing Program Manager, Philip Talley, at 217-522-5687, or insurancebilling@ipha.com.
Billing for CHW Services, One Health System’s Journey
Friday | March 21 | 12:00 PM – 1:00 PM CST.
Presented by Gregory Scott, MS, BSN, RN, PHRN, TNS, Paramedic, CDP, CHW; Community Wellness and Faith Community Health Services at Carle Health.
This presentation will provide participants with an overview of the allowable charge codes available through CMS for CHW services. The presentation will discuss the complexities of applying charge codes for CHW services. The presenter will share the experiences of one health system’s journey to begin billing for CHW services.
Click here to join the webinar.
Understanding New Medicaid Coverage for Lactation Services in Illinois
Wednesday | March 26 | 12:00 PM – 1:00 PM CST.
Presented by Margaret Saltysiak, IBCLC, MPH, Doctor of Public Health student. Margaret is a private practice owner, an instructor at UC San Diego, and the chair of the North Central Breastfeeding Task Force. She will provide practical guidance on Illinois’ new Medicaid lactation coverage, helping providers enroll, bill for services, and advocate for equitable access to breastfeeding support.
Lactation professionals play a critical role in ensuring equitable access to breastfeeding support. With the new Medicaid coverage expansion in Illinois, more families will have access to lactation services, but many providers are unaware of the details of this policy and how to participate. This one-hour training will provide lactation consultants and healthcare professionals with a clear understanding of the new Medicaid bill, who it covers, what services are included, and how providers can enroll to receive reimbursement.
By the end of this session, participants will have the knowledge and tools to take actionable steps toward enrolling as Medicaid providers and advocating for increased access to lactation services.
- Describe the key elements of the new Medicaid coverage for lactation services in Illinois, including eligibility requirements and covered services.
- Identify the process for enrolling as a Medicaid provider, including credentialing, documentation, and billing procedures.
- Explain the role of the Illinois Public Health Association (IPHA) in developing a billing hub and how it can support lactation professionals.
- Analyze the impact of Medicaid lactation coverage on health equity, particularly for families who struggle to access lactation support.
- Apply the knowledge gained to take actionable steps toward enrolling as a Medicaid provider and advocating for equitable access to lactation care.
This training is ideal for IBCLCs, CLCs, WIC staff, nurses, midwives, doulas, and other maternal-child health professionals who provide breastfeeding support and want to expand access to their services through Medicaid
Click here to register for this webinar.
The Illinois Association of Medicaid Health Plans (IAMHP) will be presenting the following trainings:
- Thursday, April 3, 12:00 – 12:45 PM CST, Sip & Refresh webinar, IMPACT Provider Enrollment and Eligibility.
- Thursday, April 17, 12:00 – 1:00 PM CST, Lunch & Learn webinar, Best Practices for Meeting HEDIS Measures.
- Thursday, May 1, 12:00 – 12:45 PM CST, Sip & Refresh webinar, Ordering, Referring, and Prescribing for Medicaid.
Recent Trainings
During the month of February, the IPHA Third-Party Billing team hosted the following webinars:
Aetna Better Health of IL (ABHIL)
Please see the Provider Quick Reference Guide for easy access to the most frequently used tools and resources to support contracted providers.
The next ABHIL New Provider Orientation Training will be held Wednesday, March 26, 12:00 PM – 1:00 PM CST. To register, please click here.
BlueCross BlueShield of Illinois
The March issue of Blue Review is available here.
BCCHP and MMAI New Provider Orientations will be held on March 20 and April 17. Click here for more information.
The Provider Quick Refence Guide provides a convenient summary of provider services, claims resources, and medical management tools
Humana has recently released their 11th Value Based Care Report. Data and stories highlighted in this report provide compelling evidence of the benefits of value-based care.
The Q1 2025 issue of Humana Physician News is available here.
Making it Easier is a self-paced series of tutorials designed to make working with Humana easier for their contracted providers.
A FQHC/RHC Orientation will be provided on Wednesday, April 9, 2:00 PM – 3:00 PM CST. Click here to register.
Click here to download Meridian’s Quick Reference Guide for providers.
The Molina Provider Relations Team has issued their First Quarter Provider Newsletter. Plus a special Newsletter Supplement specifically for Illinois providers.
A Rate/Fee Schedule Update has been issued for March 2025
Molina has recently published a Provider Memo introducing their Member Identification Toolkit. A member ID card alone is not sufficient proof of current membership. The Member Identification Toolkit outlines various ways to verify member eligibility.
Molina has also issued a Provider Memo reminding providers that HFS requires providers to submit monthly roster updates. Accurate, up-to-date rosters are critical to providing timely, appropriate care for patients. Updated rosters should be sent each month to the MHIL Provider Relations team at MHILProviderNetworkManagement@MolinaHealthcare.com.
The March issue of Network News contains important notifications and updates for healthcare providers.
The Centers for Medicare and Medicaid Services (CMS) Medicare Learning Network (MLN) has issued an important notification pertaining to Part B preventive vaccine updates that will be going into effect as of July 1, 2025. You can view the notification here.
HFS has recently issued several important Provider Notices:
- New Preferred Blood Glucose Supplies
- Certified Community Behavioral Health Clinic Claim Submission Available for Fee-For-Service Claims
- HFS Family Planning Program – Allow Signature of Minor on Application
- Integrated Assessment and Treatment Planning (IATP): Child and Family Team Building Guidance (G9007)
- Community-Based Behavioral Services Handbook - Update
- Provider Notice - Coverage of Human Papillomavirus (HPV) Vaccination Ages 46 and Up per Public Act 103-0102
- Provider Notice - Abrysvo™ (Respiratory Syncytial Virus Vaccine) - Seasonal Update
If you have not already subscribed to receive email notifications from HFS when new Provider Notices are posted, you may subscribe here. To learn more about the many helpful resources available to healthcare providers, please visit the HFS Provider website.
If you have any questions or suggestions for topics that you would like to see covered in future issues of the IPHA Billing Digest, please email your suggestions and/or requests to insurancebilling@ipha.com. To view past issues of the Billing Digest and archived Third-Party Billing training webinars, please visit the IPHA Third-Party Billing page.
Thank you!
