VII. Billing Requirements

Unique Identification

The Recipient Identification Number (RIN) is required for all client/patients supported by Department funds. Providers must request a RIN from DHS, if the client/patient does not have one, prior to billing for any service.

Service Data Reporting (Billing)

Most billing is accomplished electronically utilizing DARTS (Department's Automated Reporting and Tracking System). Appropriate software containing this system is provided free of charge. A flow chart outlining the steps in the billing process is included with this manual.

Providers can report DARTS and third party service data on a weekly basis using file transfer protocol (FTP) but must report data at least monthly. Providers shall also report any other data so requested by DASA by the prescribed time lines. The preferred method of reporting service data is through software supplied by the Department for any such service that can be reported through this mechanism. The Department assumes no responsibility for late, incomplete or inaccurate data produced by any software.

An adjustment to future disbursement or a suspension or termination of contract may occur unilaterally and without prior notice if a provider is late reporting any required financial or service data. Disbursement may be reinstated when all data is submitted and approved by DASA. Providers shall be given immediate notice when such suspension or termination has occurred by DHS/DASA.

DASA may conduct random reviews to determine accuracy of provider's service data. The provider shall be able to verify data entries upon request. DASA may delay or suspend disbursement or terminate funding immediately without prior notice if the provider produces late reporting. Late reporting is defined as late for two consecutive months or for any three months during the fiscal year. DASA shall immediately notify the provider that such delay, suspension or termination has occurred.

The provider agrees to notify DASA immediately through a written request to the Help Desk upon discovery of any problem relative to the delivery of or submission of any required service or financial data.

Data Reporting Errors

Services will be rejected for errors in data entry or for errors related to the recipient's eligibility status. If services are rejected in the Edit and Balance process that occurs at DASA, the provider will receive this information in an Accepted/Rejected report in Mobius. Providers should review these errors to see if correction is necessary and resubmit, if appropriate.

In all instances, if an error occurs and the service can be rebilled, the service should be resubmitted utilizing DARTS. Please remember that services should be resubmitted as close to the date of the error report as possible.

Monitoring/audits

DASA monitors the patterns, accuracy, and timeliness of provider reporting to determine compliance with programmatic contractual conditions and conducts post-payment audits to determine compliance with required clinical, administrative, and financial standards.

Patient and financial records are meant to substantiate compliance. Providers must establish and maintain audit trails to document services delivered and billed to eligible patients. Financial and patient record completeness, and accuracy are essential for demonstrating compliance and to avoid financial penalty.

LATE PAYMENT/SERVICES SUBMISSION

DASA has two established billing periods:

• Medicaid Funds: Medicaid funds can be paid if accepted for payment and processed within 12 months of the date of service and if the bill does not exceed the established fiscal year obligation.
• All Other DASA Funds: Any other DASA funds can be paid if they are delivered within the applicable state fiscal year, accepted for payment before annually established dates relative to the end of the lapse period and do not exceed the established fiscal year amount of funding contained in the contract.

Payment or Acceptance of Services Beyond Established Billing Periods:

• Requests for payment or service acceptance beyond established billing periods are allowable if the delay in submission was due to DASA or Healthcare and Family Services (HFS) processing.
• Requests for service acceptance or reimbursement from DASA funds other than Medicaid may only be submitted for the prior state fiscal year. Requests for reimbursement from Medicaid may only be submitted up to two years from the date of service. All requests shall be in writing and include the reason the established billing period was exceeded. Supporting documentation must be attached. All requests must also adhere to the conditions specified in the DASA contract, applicable manuals and/or letter of agreement or memorandum of understanding. If the request is for reimbursement from a federal project fund, it must reference the federal grant fiscal year funding as specified in the DASA contract. All other requests for reimbursement shall be for the same type of program funds identified in the DASA contract.

 If the request is denied, it will be for one of the following reasons:

 If the request is approved, DASA will apply the appropriate service credit or approve the services for reimbursement from the Illinois Court of Claims. All such approvals are subject to on-site and/or electronic audit. All requests will be responded to in writing and will specify the reason for the denial or acceptance.