When an appeal decision or court order requires payment of medical bills older than 12 months:
- (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.
- Ask the provider to include any billing rejection notices if the bill was submitted before.
- (FCRC) Complete Split Billing Transmittal (Form 2432), if the case was in spenddown and the date of service was a split bill day.
- (FCRC) Give Form 2432 to the provider.
- (Provider) Returns Form 2432 to the FCRC with proper claim form attached.
- (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.
- (FCRC) Sends transmittal memo with the provider's bill attached to:
Bureau of Claims Processing
P. O. Box 19118
Springfield, IL 62763-0001
- (Bureau of Claims Processing) Forwards information to the Bureau of Comprehensive Health Services (BCHS).
- (BCHS) Decides if payment will be made.
- Processes bill if provider is entitled to payment.
- Tells the provider and FCRC if the provider is not entitled to payment.