PM 20-03-04.

When an appeal decision or court order requires payment of medical bills older than 12 months:

  1. (FCRC) Have the provider submit a current bill for the service or item. The bill must be on a HFS prescribed billing form. Electronic claims submittal cannot be used for claims that are more than 12 months old, because proper documentation must be attached to the claim form.

    NOTE: The provider must also include any documents needed for client consent or prior approval. 

    1. Ask the provider to include any billing rejection notices if the bill was submitted before.
  2. (FCRC) Complete Split Billing Transmittal (Form 2432), if the case was in spenddown and the date of service was a split bill day.
    1. (FCRC) Give Form 2432 to the provider.
    2. (Provider) Returns Form 2432 to the FCRC with proper claim form attached.
  3. (FCRC) Completes transmittal memo with the following information:
    • reason for request,
    • circumstances of the late billing, and
    • the date of the appeal decision or court order.
  4. (FCRC) Sends transmittal memo with the provider's bill attached to:

    Bureau of Claims Processing
    P. O. Box 19118
    Springfield, IL 62763-0001

  5. (Bureau of Claims Processing) Forwards information to the Bureau of Comprehensive Health Services (BCHS).
  6. (BCHS) Decides if payment will be made.
    1. Processes bill if provider is entitled to payment.
    2. Tells the provider and FCRC if the provider is not entitled to payment.