Billing Digest - February, 2025

February 2025

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.

IPHA Third-Party Billing Forums – Coming Soon to a Location Near You

As part of our IDPH-funded Third-Party Billing project, IPHA will be hosting regional meetings to provide information about billing and revenue cycle management (RCM) resources available to health departments and community-based organizations. Three regional Third-Party Billing Forums are scheduled for the month of April:

Northern region – April 17, 9:00 AM – 1:00 PM, at the Will County Health Department and Community Center, Joliet IL
Central region – April 3, 9:00 AM – 1:00 PM, at the Peoria City/County Health Department, Peoria, IL
Southern region – April 9, 10:00 AM – 2:00 PM, at the Rolland Community Building, Mt. Vernon, IL (This meeting will be held in conjunction with Southern IL Public Health Consortium’s Bookkeepers’ meeting)

Please save the date for the forum in your region and watch your email for more details.

Important News from HFS

The Illinois Department of Healthcare and Family Services (HFS) has invited all healthcare providers to attend their next Clinical Collaborative Group (CCG) webinar scheduled for February 27^th from 12:00 PM – 1:00 PM CST. These webinars are being presented in conjunction with the HFS HealthChoice Illinois ADT program. This webinar series provides a forum for healthcare professionals to learn about the latest advancements, updates, and best practices in care collaboration. To learn more, please see the HFS CCG website. To register, please click here.

The HealthChoice Illinois ADT program is sponsored by HFS at no cost to providers.

The Illinois Association of Medicaid Health Plans (IAMHP) will be presenting the following trainings:

Friday, February 21, 12:00 – 1:00 PM CST, Lunch & Learn webinar, Billing for Community Mental Health Centers.
Thursday, March 6, 12:00 – 12:45 PM CST, Sip & Refresh webinar, Common Billing Challenges.
Thursday, March 20, 12:00 – 1:00 PM CST, Lunch & Learn webinar, IMPACT and Billing Basics.
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.

Recent Trainings

During the months of January and February, the IPHA Third-Party Billing team hosted the following webinars:

Overview of 2025 CMS Final Rule and Medicare Fee Schedule
UnitedHealthcare Provider Tools and Services
Value Based Payment Models

On January 23, Getting to Zero IL (GTZ) hosted a special Community Conversation to discuss Illinois Department of Insurance Bulletin 2024-18. This important bulletin eliminates financial and administrative barriers to accessing PrEP and PEP and expands coverage for follow-up care like counseling and side effects management. If you were unable to join the webinar, or if you’d like to watch again, here is the link to the recorded webinar. The slide deck can be found here, and a one-page summary can be found here.

Aetna Better Health of IL (ABHIL)

IMPACT Revalidation Process - All Medicaid providers must revalidate their enrollment.
Winter 2025 Provider Newsletter – Aetna Better Health of Illinois
Provider Network Notification EFT/ERA registration vendor services.
Network Relations contact information and coverage areas.
Provider Relations Assignment List (with contact information) is accessible via the Provider Resources tab of the ABHIL Provider website.

Reminder, Aetna Better Health of IL (MEDICAID) and Aetna Better Health Premier Plan MMAI have similar names, however, these are two separate operating health plans; each serving Members having specific eligibility requirements to participate in each plan.

Inquiries related to Commercial (private plans) and Aetna Better Health Premier Plan MMAI are facilitated by separate teams.

Aetna Better Health Premier Plan MMAI

1-866-600-2139

The contact information for the commercial and Medicare lines of business is as follows:

IL Commercial/MA Aetna's Provider Service Center (PSC) 1-888-632-3862 or visit the Aetna Provider website via Availity.
Medicare medical and dental plans: 1-800-624-0756 (TTY: 711)
Non-Medicare plans: 1-888-MD AETNA (1-888-632-3862) (TTY: 711)
Dental for non-Medicare plans: 1-800-451-7715 (TTY: 711)

BlueCross BlueShield of Illinois

BlueCross BlueShield of Illinois has published the February issue of Blue Review for Providers.

For information about Medicaid plans, please visit the BlueCross Community Health Plans (BCCHP) and Blue Cross MMAI Provider Page.

CountyCare

CountyCare has published their 2025 Annual Notice for Providers.

To sign up for CountyCare provider publications, please click here.

Humana

Humana has published their Q1 2025 Newsletter – Humana Physician News and released a Value-based Care Report.

To subscribe to Humana’s provider publications, please click here.

Meridian

Meridian has published their Monthly Provider Check-In

To subscribe to Meridian’s provider publications, please click here.

Molina

Molina has published a Rate/Fee Schedule Updates for February 2025.

Be sure to review the most recent Monthly Memo Roundup.

Please register here to receive provider updates from Molina.

Illinois Department of Healthcare and Family Services (HFS) Provider Enrollment Town Hall, Thursday, March 20, 2025, 3:00 PM – 3:45 PM CST. To register, click here.

For information regarding Provider Revalidation, please visit the HFS Provider Revalidation page.

On February 14, (IDPH) published a SIREN NOTIFICATION to share certain clinical guidance documents that may have recently been removed from federal agency websites or are potentially expected to change in the future. The notification included a letter with links to the documents and resources that may have recently been removed from federal websites.

HFS has recently issued several important Provider Notices:

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!