Paper Billing to DHS for Qualified Providers
Providers, except domestic employees, that do not have the ROCS software and serve fewer than eight individuals may submit paper bills monthly to the DHS address below. Appendix 19 provides copies of the billing forms and instructions.
DHS Office of Clinical, Administrative and Program Support
Programmatic Vouchering Unit
401 North 4th Street, 2nd Floor
Springfield, IL 62702
Note: New providers must include their telephone number and attach a copy of the IRS W-9 to the first paper bill submitted to expedite payment.
Payee and Alternate Payee Information
The individual service providers (except domestic employees who are paid by F/EAs may designate an alternate payee to receive the payment or may choose to receive the payment directly from the state, consistent with federal and state Medicaid requirements as set out in 89 Ill. Adm. Code 140.24.
The individual service provider must not designate the individual or the individual's guardian or family as the payee. Doing so is contrary to Medicaid requirements and may have tax consequences for the individual, guardian or family.
To designate an alternate payee, the service provider must complete and submit Payee Designation/ Authorization Form, signed by the provider and by the alternate payee and covering the dates of the services. This form must be renewed at the start of each state fiscal year.
The service provider must mail completed Payee Designation/Authorization Forms to the address below:
DHS - Division of Developmental Disabilities
Medicaid Waiver Unit
319 East Madison Street, Suite 3M
Fax: (217) 558-2799
Only a formally designated payee may submit bills for another service provider, except the fiscal employer agent will pay and transmit claims on behalf of domestic employees.
All payees must be established with DHS and the Office of the Comptroller. See Appendix 13 for required form, Request for Taxpayer Identification and Certification (IRS W-9), and instructions.
Service providers that do not wish to receive payment directly from the State do not need to complete an IRS-W-9.
For domestic employees, the fiscal employer agent (ACES$) will issue a W-2 at the end of each calendar year. For other providers or payees who require one, the State will issue an IRS-1099, miscellaneous income form, at the end of each calendar year.