October 2025

Leaves are Falling, Billing is Calling!

Fall is here—bringing cooler days, colorful leaves, and a fresh start to wrap up the year strongly! It’s also a great time to take stock of your billing processes, catch up on updates, and get ahead before the busy winter months. In this edition of the Third-Party Billing Digest, we’re sharing practical tips, reminders, and resources to help keep your public health billing running smoothly. So, grab a cozy drink, settle in, and let’s dive into what’s new this season in the world of billing and reimbursement.

Illinois Department of Public Health (IDPH) released new fall virus respiratory guidance and issued a statewide standing order to ensure access to COVID-19 vaccines. IDPH adopted this fall guidance after robust discussion and votes made by the Illinois Immunization Advisory Committee (IL-IAC) on September 22, 2025. Federal insurance programs, fully insured plans subject to the Affordable Care Act, and state-regulated insurance programs will cover COVID-19 shots. Most private insurances have also indicated their intention to continue covering the COVID-19 vaccine, as indicated by Dr. Sameer Vohra, Director of IDPH, in the Dear Colleague Letter dated September 23, 2025.

Center for Medicaid and Medicare Services (CMS) Part B preventative vaccine updates have gone into effect as of July 1, 2025. Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) may file for reimbursement of the cost of Medicare Part B vaccines, as well as the cost of vaccine administration at the time of vaccine administration. Part B vaccines include: pneumococcal, influenza, hepatitis B, and COVID-19 vaccines. To learn more about this change, please find a link to the Medicare Learning Network (MLN) notification here.

Blue Cross Blue Shield of Illinois, on or after November 16, 2025, will update the Lyric software database to better align coding with the reimbursement of claim submissions for primary and secondary editing. Among the changes, the Sexually Transmitted Infection Multi-Code will be rebundled. You can find more details here: Five New Claims Editing Rules will be Implemented November 2025 | Blue Cross and Blue Shield of Illinois

Illinois Association of Medicaid Health Plans (IAMHP) will host the 2025 Annual IAMHP Conference, Navigating Change, October 27-28 in Oak Brook, Illinois. This event focuses on advancing innovation, equity, and quality in Medicaid. To learn more, or to register, Click Here.

Blue Cross Blue Shield of Illinois invites you to join the upcoming live webinars:

• Prenatal and Postpartum Care and Prenatal Depression Screening and Follow Up on November 4 from 12:00 to 12:30 PM. Register Here.
• Blue Cross Blue Shield of Illinois offers free webinars and workshops for contracted providers. A list of On Demand trainings and Upcoming webinars can be found here.

Molina Healthcare of Illinois invites you to join the upcoming live webinars:

• Doula Billing, Monday, October 20, 1:00 PM Register here
• Vaccine Billing, Tuesday October 21, 1:00 PM Register here
• Appeals and Grievances Process, Wednesday, October 29, 1:00 PM Register here
• Lactation Consultant Billing, Wednesday, November 5, 1:00 PM Register here
• FQHC/RHC/Encounter Clinic Billing, Thursday, November 13, 1:00 PM Register here
• Doula Billing, Monday, November 17, 1:00 PM Register here
• HCBS and Home Health Billing, Tuesday, November 18, 1:00 PM Register here
• Lactation Consultant Billing, Thursday, December 11, 1:00 PM. Register here
• Doula Billing, Tuesday, December 16, 1:00 PM. Register here

Live Provider Webinars on Upcoming DSNP Plan going into effect January 1, 2026. Details to register can be found here.

Looking for something else? Explore the 2025 schedule of live webinars exclusively for Illinois providers. Meanwhile, register for provider updates to receive notices for upcoming sessions.

Aetna Better Health of Illinois

The Fall Newsletter can be found here.

Contact your Provider Relations representative with any questions.

BlueCross BlueShield of Illinois

A few common billing errors typically cause most denials of claims for members of Blue Cross Community Health Plans. For resources to help your claims process more smoothly and avoid delays in payment for service dates prior to August 1, 2025, visit Avoid Many Denials of Medicaid Claims with Help from New Resources | Blue Cross and Blue Shield of Illinois

The October 2025 issue of Blue Review is available here. If you have not already subscribed to receive this publication, you may sign up here.  

To contact your Provider Network Consultant, visit Provider Network Consultant Assignments for more information.

Humana

The Q3 2025 issue of Humana Physician News is available here. If you have not already subscribed to receive publications from Humana, you may sign up here.

The Humana Gold-Plus Integrated provider manual, effective June 15, 2025, can be found here.

Humana’s Resource Sheet for Healthcare Providers is a one-stop resource containing essential information on a variety of important topics for providers.

Meridian

September 2025 Monthly Provider Check-In can be found here.

Meridian recently updated Resolving Common Claims Rejections, a resource providing tips on resolving and avoiding rejected claims.

Contact your assigned Provider Engagement Administrator or representative for support. For those without an assigned representative, complete this intake form or contact Meridian using the information here.

Molina

Molina is sharing a summary of recent news pertinent to your practice/facility. Memo topics include: Rate/Fee Schedule Updates for September, Updates to Molina Clinical Policies, and much more! You can find the ‘Memo Roundup’ here. To register for Illinois provider updates, so you don’t miss any bulletins, Click Here.

The Third Quarter Provider Newsletter, Illinois Edition, can be found here.

Contact your dedicated Provider Relations Manager or email the Provider Relations team at MHILProviderNetworkManagement@MolinaHealthcare.com. To help identify your dedicated Provider Relations Manager, visit Molina's Service Area map.

United Healthcare

The October 2025 issue of Network News contains important notifications and updates for healthcare providers.  

The October 2025 Reimbursement Policy Update can be found here.

The News Your Way feature allows you to customize your subscription to receive information and updates specific to your role, specialty, and state. Click here to subscribe or update your preferences.   

Illinois Association of Medicaid Health Plans (IAMHP) released the September 2025 Newsletter. The issue is full of excellent information and topics, including a discussion on new Medicaid work requirements; a legislative session recap; and a Feature Article that focuses on the Impact of Federal Legislation, focusing on provider and MCO taxes.

The Centers for Medicare and Medicaid Services (CMS) offers practical tools that walk providers through the proper use of Z codes: Using Z Codes and Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z Codes. Using Z codes to Improve Patient Health: Z codes are a group of International Classification of Diseases (ICD-10-CM) diagnosis codes that describe factors other than disease or injury. Rather, they document the patient's economic, social, and environmental circumstances, like problems related to Social Determinants of Health (SHOH)

Revalidation Town Halls (2025): The Centers for Medicare and Medicaid Services (CMS) require state Medicaid programs to revalidate all actively enrolled Medicaid providers at least every five years. For upcoming Revalidation Town Halls visit here.

Electronic Visit Verification (EVV) is a technology-based system that efficiently verifies home healthcare visits. EVV reduces the likelihood of error while promoting program integrity through practical and simple monitoring. There are a variety of ways to ensure you do not miss important updates or information:

• Sign up for Illinois Department of Healthcare and Family Services (HFS) EVV Provider Notices.
• Visit Illinois’ Electronic Visit Verification (EVV) website.
•  View September 2025 Town Hall Slides here.

Fee Schedule Update for School Based/Linked Health Center Fee Schedule was updated on August 29, 2025.

A complete list of HFS Provider Notices can be found here.

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.