Ill. HFS Handbook for Hospice Agencies, Topic K-200

For consideration for payment by the Department for hospice services, such

services must be provided by a provider enrolled for participation in the

Department’s Medical Programs via the web-based system known as Illinois

Medicaid Program Advanced Cloud Technology (IMPACT). Services provided must

be in full compliance with applicable federal and state laws, the general provisions

contained in the Chapter 100, Handbook for Providers of Medical Services, General

Policy and Procedures, and the policy and procedures contained in this handbook,

as well as the applicable provisions contained in 42 CFR Part 418.1 through

418.405. Exclusions and limitations are identified in specific topics contained herein.

The billing instructions contained within this handbook are specific to the

Department’s paper forms. Providers billing the facility services described in this

handbook use the UB-04 claim form for billing paper claims. The instructions apply

to patients enrolled in traditional fee-for-service and do not apply to patients

enrolled in Managed Care Organizations (MCOs) and Managed Care Community

Networks (MCCNs). Further information can be found at the HFS Care Coordination

website.

Providers wishing to submit X12 electronic transactions must refer to Chapter 300,

Handbook for Electronic Processing. Chapter 300 identifies information that is

specific to conducting Electronic Data Interchange (EDI) with the Illinois Medical

Assistance Program and other health care programs funded or administered by the

Illinois Department of Healthcare and Family Services