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December 2025
"Billing" Through the Snow!
A Holiday Edition for Illinois Public Health Partners
The holiday season arrived in Illinois with a flurry of snow and end-of-year activities, which have kept public health agencies busy serving their communities—and third-party billing teams working behind the scenes. You will note this edition of our Third-Party Billing Digest is a bit lighter than normal. We know this is a busy time of year and it was our goal to make this issue succinct but packed with helpful information and resources. Do not fear! We will resume our usual format in January so consider this our Happy New Year gift to you.
Dominic started at IPHA on October 20, 2025 as the HIV and Third-Party Billing (TPB) Program Manager. Dom is quickly acclimating to all things billing and has been an excellent addition to the Team! He will serve as the primary billing contact starting February 2026, which includes curating and producing the monthly Billing Digest. Please continue to submit your Billing-related questions to insurancebilling@ipha.com so the whole TPB team receives your inquiry. Get to know a little more about Dominic below.
Dominic Musgrove
I’m Dominic Musgrove, a Western Illinois University alum originally from Southeast Wisconsin—and yes, a proud Packers fan. For the past four years, I worked with The Project of the Quad Cities, where I supported care for individuals living with HIV by addressing billing challenges and collaborating with providers and insurance partners to navigate complex billing and coding issues.
I’m excited to step into the role of Third-Party Billing Manager across the state of Illinois for IPHA, focusing on problem-solving and streamlining systems that reduce barriers and create smoother workflows for both clients and providers. I’m especially passionate about strengthening billing practices that support aging individuals living with HIV.
As the middle child in a big family, I’ve learned a lot about patience, collaboration, and navigating complex situations—skills I bring to this work every day. I look forward to partnering with teams across Illinois to advance efficient and effective billing solutions.
As we close out the year, the Third-Party Billing Team would like to extend our sincere thanks to YOU for your continued partnership and dedication to public health. Your work makes a meaningful difference in our communities every day, and we are grateful to support you behind the scenes. We wish you a joyful holiday season, a well-earned moment of rest, and a smooth start to the new year—filled with good health, strong collaboration, and clean claims.
Revisions to Comprehensive Billing Guide for Medicaid Managed Care Services-Version 35.0. The Illinois Medicaid Managed Care Organizations (MCOs), in collaboration with the Illinois Association of Medicaid Health Plans (IAMHP), have developed a Comprehensive Billing Guide for HealthChoice Illinois providers. This billing guide is designed to help providers who are contracted with the MCOs understand the general MCO billing requirements. MCOs have different policies and procedures related to billing. With this manual, the MCOs have created a single source of information for all claims regardless of provider type. As different sections of the Comprehensive Billing Guide are finalized and published, the Illinois Department of Healthcare and Family Services (HFS) will update providers via a provider notice by listing the revisions.
Version 35.0 of the IAMHP Comprehensive Billing Manual has been released and posted at https://iamhp.net/providers.
Incorrect Denials for CPT 90480: Centers for Medicare and Medicaid Services (CMS) is aware of a current issue related to National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits for current procedural terminology (CPT) code 90480, COVID-19 vaccine administration. The PTP edits implemented on October 1, 2025, are causing incorrect claim denials when providers bill for COVID-19 and other vaccines provided on the same day. Claims with dates of service on and after October 1, 2025, are the ones who are impacted. To remedy this, Medicare Administrative Contractors (MACs) should have received the January 2026 NCCI PTP files in November. Once the new files are implemented, claims will no longer be denied in error. No provider action is required.
Beginning January 1, 2026, HFS will allow the maximum dispensing of a 12-month supply at once of contraceptives. More information can be found in the Provider Notice issued 12/4/2025.
- Medicare Part B: Ask NGS—A Let’s Chat session. These open forum virtual sessions connect you directly with CMS subject matter experts for clarification on key Medicare topics and are designed to keep you informed about current policies, billing procedures and updates. The first session is scheduled for 1/15/2026, from 11:00 a.m.–12:00 PM ET. Presubmitted questions are requested by 1/5/2025. Send your questions to JKPartBPOE@elevancehealth.com with ‘NGS ASK’ on the subject line. As many questions as possible will be addressed and post a question-and-answer summary shortly after the call. Register HERE
- Federal Rural Health Update, Illinois Rural Health Association Winter Webinar Series, February 3, 2026, 3:00 PM Register HERE
- Molina HFS Revalidation Town Hall, December 18, 2025, 10:00am. Register HERE
- Molina D-SNP Plan Introduction, December 19, 2025, 2:00 PM Register HERE
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. Your feedback is valuable and appreciated.
Thank you!
