The information contained within this manual is applicable to any Medical Benefits, All Kids and Family Care. All providers shall be certified and enrolled to provide substance abuse treatment services as authorized by the Department of Human Services (DHS), Division of Alcoholism and Substance Abuse (DASA). Providers will bill Medical Benefits, All Kids and Family Care services as appropriate using the DARTS software. The policies and procedures contained within this manual are based upon those set forth in the Department of Healthcare and Family Services (HFS), Chapter 100 and rules and/or contract conditions in effect for Fiscal Year 2012. Where applicable, the specific source of the mandate is referenced. Providers can find Chapter 100 in its entirety at: (www.state.il.us/dpa/handbooks.htm)
The rates established to reimburse represent what DHS/DASA has determined it will pay for each service. However, the applicable rate may not always cover the actual cost of the service. Additionally, Medicaid payments made to providers for services to eligible participants are considered payment in full. If a provider accepts the patient as a Medical Programs participant, the provider may not charge eligible participants for co-payments, participation fees, deductibles, or any other form of patient cost-sharing, except as specifically allowed in Chapter 100. In no other instance may any form of patient cost-sharing be charged to eligible participants for any DASA covered services. Providers may not make arrangements to furnish more costly services or items than those approved by DASA for payment on condition that patients supplement payments made by DASA Medicaid.
Any patient's treatment reimbursed by a third party provider (i.e., DASA contract, insurance, etc.) cannot be billed at a rate lower than the Medical Benefits, All Kids and Family Care approved rate for the individual service.
Full compliance with and a thorough understanding of DHS/DASA rules and procedures is expected of all providers who are certified to deliver Medicaid eligible substance abuse services. The majority of billing errors that cause delay or recoupment of payment can be prevented by correct utilization of reporting software and adherence to procedures established in this manual.