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April, 2025
IPHA’s Regional Third-Party Billing Forums: Fueling Success Through Training, Networking, and Partnerships
IPHA’s Third-Party Billing team hit the road this month, hosting three regional forums in Peoria, Mt. Vernon, and Joliet respectively — all with one goal in mind: strengthening partnerships between public health providers, community-based organizations (CBOs), and third-party payers.
These forums were facilitated with funding from IPHA’s Third-Party Billing contract with Illinois Department of Public Health (IDPH). Each forum brought together a dynamic mix of providers, partners, and payers for open conversations, real-time learning, and meaningful networking. It was a chance to make new connections and strengthen existing relationships all in one room.
One of the biggest highlights for the more than 150 attendees was hearing directly from Illinois’ Medicaid managed care organizations (MCOs). Providers had the chance to meet MCO representatives face-to-face, ask questions, and gain a better understanding of each MCO’s procedures and resources. IPHA also hosted panel discussions to discuss current and upcoming issues that will impact Illinois’ healthcare community.
These forums wouldn’t have been nearly as impactful without our guest speakers. We would like to thank the following colleagues for sharing their knowledge and experience:
- Emily Hendrickson, RN, MSN, Director of Nursing for Adams County Health Department and President of Illinois Public Health Administrators, presented at the forum in Peoria on April 3rd.
- Meredith Vogel-Thomas, RMA, Office & Billing Manager, Morgan County Health Department, presented at the forum in Mt. Vernon on April 9th.
- Adriana Milan, MPA, SHRM-SCP, Director of Administrative Services, DeKalb County Health Department, presented at the forum in Joliet on April 17th.
- The team from CDP, Inc. and ezEMRx; MikePeth, Siri Kumar, and Devang Patel.
IPHA would also like to thank Jill Hayden and Rachel Thomas from the Illinois Association of Medicaid Health Plans (IAMHP) for their assistance and support. We’re also incredibly grateful to the MCO representatives that participated in each forum. Your partnership and dedication are greatly appreciated.
Additionally, IPHA thanks the Peoria City/County Health Department, the Will County Health Department and Community Health Center, and the Southern Illinois Public Health Consortium’s Fiscal Group for welcoming us and helping make everything run smoothly.
The presentation slides and other materials from all three forums will be shared on the IPHA’s Third-Party Billing webpage soon.
These forums were a reminder of just how powerful collaboration can be. By coming together, sharing real experiences and working through challenges, we’re building stronger systems and stronger relationships across Illinois.
ACT NOW: Funding Available for Electronic Health Record (EHR) with Billing Services
IPHA’s current Third-Party Billing contract year with the Illinois Department of Public Health (IDPH) ends on May 23, 2025. One of the primary objectives of this project is to expand the use of Electronic Health Records (EHR) at local health departments (LHDs) and community-based organizations (CBOs). To help achieve this, project funds are available to qualified LHDs and CBOs 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 or billing system. Funding is limited and must be secured before May 23, 2025.
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.
IAMHP’s MCO RSV Vaccine in Pregnancy Billing Guide
In response to inquiries from several health departments, IPHA and Illinois Public Health Nurse Administrators Association (IPHNA) have been working with personnel at IAMHP and the MCOs to resolve issues related to billing for RSV vaccine for pregnant women. IAMHP has provided a Billing Guide outlining the medical billing requirements for the RSV vaccine when provided to a pregnant patient.
Please continue to work directly with each MCO to resolve any outstanding claims. We are grateful to our colleagues at IAMHP and the MCOs for their cooperation and support in addressing this important issue.
Upcoming Trainings
The Illinois Association of Medicaid Health Plans (IAMHP) will be presenting the following trainings:
- Thursday, May 1, 12:00 – 12:45 PM CST, Sip & Refresh webinar, Ordering, Referring, and Prescribing for Medicaid.
- Thursday, May 15, 12:00 – 1:00 PM CST, Lunch & Learn webinar, The Importance of a HEDIS Performance Strategy.
- Thursday, June 18, 12:00 – 1:00 PM CST, Lunch & Learn webinar, Utilization Management.
- Thursday, July 3, 12:00 – 12:45 PM CST, Sip & Refresh webinar, Universal Roster Billing.
Recent Trainings
During the months of February and March, the IPHA Third-Party Billing team hosted the following webinars:
- Billing for CHW Services, One Health System’s Journey [Handout]
- Understanding New Medicaid Coverage for Lactation Services in Illinois [Slides]
- Reinforcing Your Community's Safety Net [Slides]
- Back to Basics: Understanding and Utilizing the 340B Program to Enhance Health Outcomes for Underserved Populations
- Value Based Payment Models [Slides]
- UnitedHealthcare Provider Tools and Services [Slides]
Aetna Better Health of IL (ABHIL)
Please review the ABHIL Spring Newsletter.
The next ABHIL New Provider Orientation Trainings will be held Wednesday, May 7, and Wednesday May 21, 12:00 PM – 1:00 PM CST. To register, please click here.
ABHIL’s leadership and claims teams have provided the following Dental Varnish Claims Update:
- Code D1206 is covered for ages 0-6 years old.
- Code 99188 is not covered as it is not on the fee schedule.
- Global Issue Log (GIL) 2079 has been submitted through their claims and configuration teams to update their system to allow D1206 claims for the ages listed above and to reprocess the claims that were denied in error. Claims project is forthcoming.
- For D1206 claims with patients ages 7 and up, those claims would need to be billed to DentaQuest.
If you have any questions, please contact Michael Chad Morgan, Senior Analyst of Network Relations, morganm7@aetna.com or 618-319-3730.
ABHIL provided guidance on the ending of the Health Benefits for Immigrant Adults (HBIA) program. Please see this Provider Memo for details.
On March 14, ABHIL published a Provider Notice providing guidance on reimbursement for RSV vaccination claims.
BlueCross BlueShield of Illinois
The April issue of Blue Review is available here. If you have not already subscribed to receive this publication, you may sign up here.
Blue Cross Community Health Plans (BCCHP) will be hosting their BBCHP and MMAI Q2 Community Stakeholder Committee Meeting on Thursday, May 15, 1:00 – 2:30 PM CST. To learn more and to register, please click here.
The Q1 2025 issue of Humana Physician News is available here.
Humana’s Resource Sheet for Healthcare Providers is a one-stop resource containing essential information on a variety of important topics for providers.
April’s Monthly Provider Check-In can be found here.
On April 9, Meridian published an Availity Essentials Transition Update regarding claims corrections, Remittance Viewer, PCP notifications, and more.
The Molina Provider Relations Team issued their Monthly Memo Roundup.
Molina recently published a Provider Memo regarding Prior Authorization for COVID-19 vaccinations for certain non-par providers starting with service dates on or after July 1, 2025.
Molina's Doula and Lactation Consultant Materials:
Molina Healthcare of Illinois released two provider memos reaching out to doulas and lactation consultants.
- Doula Provider Network, MHIL Provider Memo, Molina Healthcare of Illinois
- Lactation Consultant Provider Network, MHIL Provider Memo, Molina Healthcare of Illinois
Molina also created two webinars and made the slide decks accessible online:
The webinar sessions for doulas and lactation consultants are located on Molina’s website at Provider Education Series - Webinars (open the Billing and Coding section; webinars are listed alphabetically). Below is a list of upcoming webinars; all begin at 1:00 PM:
- Lactation Consultant Billing, Mon. May 5
- Doula Billing, Thurs. May 15
- Lactation Consultant Billing, Mon. May 19
- Doula Billing, Fri. May 30
The April issue of Network News contains important notifications and updates for healthcare providers.
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.
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 for Rural Health Clinics and FQHCs. You can view the notification here.
HFS has recently issued several important Provider Notices
- Update - Health Care Eligibility Benefit Inquiry and Response
- Health Benefits for Immigrant Adults (HBIA) – Notice of Coverage Ending Effective June 30, 2025
- Initiation of Buprenorphine – Medication for Treatment of Opioid Use Disorder (MOUD)
- Updates to the Illinois Medicaid Crisis Assessment Tool (IM-CAT)
- Introduction of Electronic Clinical Review Platform for Managing Prior Authorizations for Adaptive Behavioral Support (ABS) Services
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.
Thank you!
