IL444-4280B - EI ADM Summary Expenditure Documentation Form (EDF) and related instructions - To be released....

The Illinois Department of Human Services (DHS), Division of Family and Community Services (FCS) contracts for Central Billing Office (CBO) services for its Early Intervention (EI) Program.

Specifically, CBO will:

  • adjudicate provider service claims by providing services to generate vouchers and payment records for processing claims with continued expansion of the number processed annually. This process requires meeting the Health Insurance Portability and Accountability Act (HIPAA) Transaction Code Set Standards. Processing claims also requires updating annual Individual Classification of Diseases (ICD) codes and maintaining procedure code updates provided by the Department. All processed vouchers must be able to be processed through the Department's Accounting System and the State Comptroller. The record of vouchers processed during the previous weekly time-frame must be submitted to the Department.
  • submit claims of Medicaid-eligible participants to the Illinois Department of Healthcare and Family Services (HFS) including provide an ongoing reconciliation process based upon the receipt of remittance advice received from HFS that encompasses write-offs, adjustments, provider enrollment problems and resubmission of claims to HFS.
  • allow for EI provider enrollment by working with the EI Credentialing contractor and the Illinois Medicaid Provider Advanced Cloud Technology (IMPACT) and conduct family fee invoicing and receivables including maintaining a family fee system to perform activities for collecting family fees, updating accounts including credits and refunds, printing invoices and mailing invoices
  • administer the insurance requirements of the EI system, including the granting of waivers and exemptions from insurance use including providing services that allow payees to submit insurance billable claims to the CBO, which will be processed and submitted to the appropriate third-party insurance company for payment to the EI payee. If insurance does not pay, EI CBO shall automatically process the claim, without requiring additional claims to be submitted to the vendor, and generate a provider claim summary to the payee, maintain participant insurance coverage information and ensure provider payments are not made on claims without proper parental consent, except those waived from insurance coverage. This includes a process of approving or denying insurance exemption and waiver requests.
  • linkage to EI services authorization data in Cornerstone (a required interface that feeds other DHS and/or EI data systems) including supporting all record maintenance functions associated with database management systems, providing a process that will accommodate the development or modification of future and current data interfaces to establish or maintain compliance with statutory, administrative rule, or policy mandates.
  • provide Parent Explanation of Benefits (EOB) for all provider claim activity for their child(Ren), to all families/caretakers.
  • provide Provider Claims Summaries (PCS) to all EI providers for claim activity
  • generate reports per DHS directives, including:
  • payments, receivables and adjustment reports
  • reports on family fee accounts including receivable, aging and delinquency
  • data sharing reports
  • routine monitoring reports
  • payee monitoring and program audit reports
  • help desk services statistics report
  • maintain an account tracking function to be used for required refunds from enrolled provider/ payees, including repayment and voluntary refunds of duplicate payments/overpayments to payees/providers
  • operate a Help Desk to provide assistance to families and providers with issues or questions with use of a call tracking system
  • operate a technical support Help Desk to technical and program staff that is available 24 hours a day, 7 days a week, 365 days a year, for information technology personnel for technical problems with calls. This Help Desk must provide:
    • System support that is readily available during regular business hours on a daily basis to assist with problem analysis and provide instructions for troubleshooting problems
    • A written escalation policy for problems that cannot be resolved by front-line Help Desk personnel
    • Emergency contact information to be available during non-business hours with a two (2) hour response time seven (7) days a week