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Billing Job Aids

The Illinois Handbook for Practitioners Rendering Medical Services provides documentation on the HFS requirement for a Patient Status Modifying unit for each anesthesia CTP/HCPCS code submitted on a claim/encounter

Harmony Health Plan, a WellCare company, requires providers to submit claims with the correct facility National Provider Identifier (NPI) and taxonomy codes for institutional claims and encounters for the State of Illinois.

Harmony Health Plan requires Providers to submit claims or encounters with the correct number of room charges for the date range, as well as report the Covered Days in Value Code 80 for submissions for Institutional claims or encounters for the State of Illinois Healthcare and Family Services (HFS) members.

Harmony Health Plan, a WellCare Company, requires LTC providers to submit claims with the correct billing and codes as if the claim was submitted to the Illinois Department of Healthcare and Family Services (HFS).

Harmony Health Plan requires providers to submit claims or encounters with the correct data required for transportation and ambulance claims or encounters for all State of Illinois Health and Family Services (HFS) members.

The Illinois HFS (Health and Family Services) Provider Notices provides documentation on the National Drug Code (NDC) submissions that the state requires for Revenue and HCPCS drug codes effective July 1, 2014.

Harmony Health Plan, a WellCare Company, requires Providers to submit claims with the correct DASA coding and data requirement for claims and encounters for the State of Illinois members.

Harmony Health Plan, a WellCare Company, requires providers to submit claims with the correct coding for claims and encounters for the state of Illinois.

The Illinois Handbook for Hospital Services (pages 48 and 49) provides documentation on Revenue Codes that the state restricts based on the member’s age.

Effective October 1, 2012, in compliance with the state of Illinois HFS informational notice dated September 10, 2012, providers were required to report Value Code 54 for newborns who are 14 days of age or less on all admission claims.

An informational notice was issued by the state of Illinois on December 11, 2011, requiring the submission of Value Codes 80 and 81 to report covered and non-covered days on institutional claims.

Harmony Health Plan, a WellCare Company, requires Providers to submit Outpatient Laboratory (Lab) claims that are not Ambulatory Procedures Listing (APL) claims on a professional CMS-1500 (02/12) paper claim form, or an 837P Electronic Data Interchange (EDI) claim or encounter for the State of Illinois.

Harmony Health Plan, a WellCare Company, requires providers to submit outpatient laboratory (lab) claims with the correct modifiers for a claim or encounter for the State of Illinois.

For Encounter Services, always bill the correct place of service (POS) considered inside the FQHC, ERC, or RHC

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Last Updated On: 11/9/2015