Illinois Workflow
Overview
(As always, private pay is generally self-regulating within the confines of state law and regulatory processes. This article focuses on Medicaid billing in the state of Illinois.)
In the state of Illinois, there are some unique billing processes. This is because select Medicaid visits must be completed using electronic visit verification (EVV), and these verified visits are required to be sent Sandata. Certain MCO users will instead be required to be sent to HHAx if applicable. For Ankota users, that means in addition to our regular EVV services which we provide, we also deliver appropriate visit data to the appropriate location to ensure your state's requirements are met. This article will help guide you through this process.
This article covers:
Billing Management for Medicaid Visits
Remittance Advice Management (835s)
Set-up
General Resources
- Community Care Program Overview
- Home and Community Based Services Waiver Programs
- FAQ for Community Care Program Billing and Reimbursement
- Provider Responsibility/Administrative Code for Community Care Program (including Vendor Request for Payment, or VRFP, requirements)
- Phone numbers for Illinois Medicaid are listed here
- Illinois Medicaid Healthcare and Family Services Contact: hfs.evv@illinois.gov
- General Contact information for DHS:
- DHS EVV Website - DHS EVV
- DHS EVV Email - dhs.evv@illinois.gov
- DHS EVV Help Line - 1-888-713-5139 (1-888-575-0531 TTY)
- DRS Local Offices - search the DHS Office Locator
HHAX Set-up
T1019, T1019 TU, and T2034 (Crisis Funding) are the visit types that must be exported to HHAX. Tasks 115-511 must also be sent to HHAX.
In short, those services are subject to the EVV mandate and must be delivered to HHAX. Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation, but registration ensures HHAeXchange will accept the data and give providers access to credentials and the HHAeXchange log-in.
To register with HHAeXchange, providers must email edisupport@hhaexchange.com the following information:
- Subject: Alt EVV - Ankota
- Body:
- Provider name: YOUR COMPANY NAME
- Provider contact name and email address: NAME, EMAIL
- Provider Medicaid ID:
- Provider Tax ID:
- Vendor name: Ankota LLC
- Vendor address: 1 Franklin Street, Suite 360B, Boston, MA 02110
- Vendor contact name & contact information: Sharon Dodge, COO, sharon.dodge@ankota.com, 844-4-Ankota, extension 703
- If you want HHAx to bill your data, request that option
Questions about IL EVV can be sent to dhs.evv@illinois.gov. Additional questions about HHAeXchange can be sent through the HHAX portal or call (866) 245-8337.
HHAeXchange will provide credentials in return. Please send Ankota the following information so that your data can flow to the state:
- Your HHAeXchange credentials
- Any HHAeXchange communications
- Your provider Medicaid ID, Tax ID, and taxonomy codes
Illinois collects the following information (this is the information that MUST be added to your system prior to data delivery):
- Type of service
- Person Serviced
- Dates of Service
- Location of Service
- (Reason & Action codes if needed)
- Payer
- Note Illinois does NOT require program specifics
- Name of Caregiver
- Times of Service (start & end time)
- Client data
- First Name Last Name
- Medicaid ID in the Medicaid ID field
- Other ID or same ID in the Client ID field
- Client address
- Primary diagnosis code (this must be the diagnosis CODE, not the description, and it must be the code assigned by the state, not a general valid diagnosis code)
- Relationship to insured
- Plan Assignment (Medicaid, Blue Cross/Blue Shield, Champus, Commercial Insurance Co. Medicare Part B, Medicaid)
- Caregiver demographic data
- First Name Last Name
- DOB
- SSN
- Gender
- Hire Date
- ID & Matching Caregiver Code (do not skip the code UNLESS you do not want the caregiver to send, like the Ankota Support caregiver)
- Professional license number if possible
- Gender
- Role for Type: ‘Both’, ‘Skilled’, or ‘Non-Skilled’ (this is under Roles)
- no other Role is allowed by HHAx
- Hire date
- Valid email and phone format (if email and phone are entered)
- Valid Address (State and 5-digit ZIP required)
Please note you can not send visit data until caregivers are successfully sent and received. Please also make sure your clients are on file with the state/HHAx per your payer. Per HHAx, "If you do not accept the [client] placements within a certain time frame they go to a pending queue...You do need to have someone check the system daily to accept new placements." You can email HHAx if you need them to re-set the clients to pending. Please also note clients must have active authorizations in order for clients' data to be accepted.
Testing
HHAX Testing
No state testing processes are required for individual vendors at this time.
Pre-Billing
Successful billing starts at the beginning of the client's creation. The processes below will lead to successful billing.
- Client Management
- Client/Caregiver Entry
- Setting Authorized Service for Clients (entering authorizations)
- Schedule Visits - Calendar-Based Scheduling (or for those who prefer the classic approach, Creating Visits from Patterns)
- Visit Management
- Caregivers complete visits or timesheets are entered manually through the office
- Visits are approved automatically or visits are approved by office
- More specifically, ensure visits are closed, then review and clear the Visit Approval Dashboard
- For HHAeXchange EVV visits,
- Prevention of Errors/Rejected Claims
- Watch your warnings on the Action Center (for missing auths, primary diagnosis codes, IDs, etc.) and address as needed
- Watch your warnings on the Visit Approval Dashboard and address as needed
- Ensure that name spellings, First Name/Last Name separation, Medicaid ID, and DOBs are entered correctly
Billing Management for Medicaid Visits
HHAX Billing
Currently, the following services require EVV management and are sent to HHAeXchange. More information is available here. Please note group homes, DDD Supported Living Services (24-hour service), and self-directed personal care services do not require EVV at this time.
This process works as follows:
- (Pre-billing process above)
- Bill visits as usual in Ankota
- Do not bill overlapping months; for example, January and February visits should be in separate invoices
- Separate out EVV and non-EVV visits to avoid unnecessary rejections from the state
- Visit data is exported to HHAx upon billing in Ankota
- Read your imported response files (see section below)
- Manage corrections
- Re-send visits as needed, usually via the Visit Approval Dashboard
- Release billing in HHAx
- See this training video for more on releasing billing in HHAx
- Please note that once a visit is accepted in HHAx, if there is an issue, that issue must be corrected in HHAx
Remittance Advice Management (835s)
Remittance advice files, or 835s, may be provided in response to filing Medicaid claims. Think of these like state receipts of payments. If you are provided with these files, they can be uploaded to Ankota for an automatic application of payments in the A/R records. For more on this process, see below.
- Process Remittance Advice(Upload 835 "receipts" received from MMIS into Ankota)
- Post Manual Payments
- Review Billing Reports
- See also: Collections Report, Exceptions Report
Corrected Claims
Generally, claims corrections are handled one of two ways:
- Update the claims in Ankota and re-send
- Update the claims in the location where it was sent
HHAX Claim Correction
To correct claims that were rejected in HHAeXchange,
- Review your HHAeXchange response files
- Correct the visits with errors as needed
- Re-send visits from Ankota by the appropriate method, either:
- single visit export
- batch visit export (re-completing the affected invoice, which triggers delivery to HHAeXchange)
Further Details
These additional resources may also be of use:
- The Ankota Training Overview, including videos
- Daily Adjustments
- Manual Visit Entry
- Private Pay Workflow