Early Intervention Central Billing Office (CBO)

The Illinois Department of Human Services (IDHS), 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 IDHS. All processed vouchers must be able to be processed through the IDHS Accounting System and the State Comptroller. The record of vouchers processed during the previous weekly time-frame must be submitted to the IDHS no later than Friday of each week.
• ensure a Health Insurance Portability Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) compliant system is utilized that can be accessed by IDHS staff to view activity of participants and billing of providers.
• allow payees to submit insurance billable claims to the EI CBO, which will be processed by the EI CBO and submitted to the appropriate third-party insurance company for payment to the payee. If insurance does not pay in accordance with IDHS approved reason(s), the EI CBO shall automatically process the claim through the EI CBO's system without requiring additional claims to be submitted to the EI CBO, and generate a provider claim summary to the payee.
• maintain client insurance coverage information through an initial high-level benefits verification to be shared with the CFC only and assure that provider payments are not made on submitted claims without parental consent, exempt or waived from insurance coverage unless a proper explanation of benefits is received denying payment for a reason that should not be challenged. This includes a process of the EI CBO processing benefits verifications, submitted claims with private insurance Explanation of Benefits indicating non-payment (following IDHS approved denial reason(s)) and approving or denying insurance exemption and waiver requests.
• submit claims of Medicaid-eligible participants to the Illinois Department of Healthcare and Family Services (HFS) and perform an ongoing reconciliation process based upon the receipt of a monthly remittance advice received from HFS that encompasses write-offs, adjustments, provider enrollment problems and resubmission of claims to HFS.
• provide updated/corrected claim information to HFS within the HFS filing limit for claims requiring updates and/or corrections as well as document claims not able to update or correct for audit purposes.
• allow for EI provider enrollment by working with the EI Credentialing contractor and the EI Data systems including Cornerstone and Illinois Medicaid Provider Advanced Cloud Technology (IMPACT).
• maintain a family fee system in cooperation with other Vendor systems including, but not limited to, the EI Lockbox Vendor and IDHS accounting systems(s), by which a process includes mechanisms to:
  • receive and account for family fees on a daily basis.
  • prepare family fee invoices and receivables
  • perform activities for collecting family fees, updating accounts including credits and refunds, printing invoices and mailing invoices.
• 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 Provider Claims Summaries (PCS) to all EI providers for claim activity
• generate reports per DHS directives, including:
  • a report showing payments, receivables and adjustments on submitted and processed payee claims (as appropriate, both paper and electronic) to be submitted to the Department on a daily basis.
  • a report on family fee accounts including receivable, aging and delinquency reports to be submitted to the IDHS no later than the 5th business day of each month.
  • specific activities designed for collecting family fees, such as updating accounts, printing invoices and mailing the invoices no later than the 5th business day of each month.
  • printing and mailing monthly delinquency letters to families as a collections activity no later than the 5th business day of each month.
  • providing Parent Explanation of Benefits (EOB), accounting for all provider claim activity for their child(ren), to all families on a monthly basis. The EOB must be printed and mailed no later than the 5th business day of each month.
  • routine monitoring reports
  • routine data sharing reports
  • monthly reports of the EI CBO's services and statistics. These reports should include progress of workgroups, initiatives as well as EI CBO departmental progress (Family Fees, Insurance Billing Unit, Benefits Verifications, Insurance Waivers, Insurance Exemptions, Provider Claims, HFS Claim Submissions, etc.)
  • payee monitoring and program audit reports
  • Help Desk monthly reports of calls received including, but not limited to category of purpose of call, number of calls, resolution to call.
• 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 relating to Family Fee Account Information, Parent Explanation of Benefits (EOB), claims process and resources for providers with questions regarding submission and/or processing of claims.
• use a call tracking system and provide monthly reports of calls received including, but not limited to category of purpose of call, number of calls, resolution to call. Tracking system shall include documentation of who received call, worked with caller and resolution/status of call content for audit purposes.
• 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
• make available staff members with the needed knowledge for quarterly, federally-required interagency council meetings. Additionally, the EI CBO shall make key staff available for bi-weekly update meetings with the department for project status updates as well as resolution discussions for issues. The EI CBO shall make key staff available for EI Partner activities including, but not limited to, monthly calls, and monthly in-person meetings with HFS staff when necessary.
• have a HIPAA/FERPA compliant communication system internally with secure access to IDHS staff as well as external stakeholders including, but not limited to, EI Partners and Child & Family Connections offices.