WAG 20-03-00: Department Responsibilities (AABD, FHP, TANF)

PM 20-03-00

(OIG-HFS Office of Inspector General) Conducts ongoing reviews of the use and quality of medical services.

  1. (OIG) Conducts investigations when provider fraud is suspected.
  2. (FCRC) Refer suspected abuse of medical services, by either clients or providers, to the HFS Administrative Services Unit (ASU) at 1-844-ILFRAUD/1-844-453-7283. All staff are required to report suspected abuse of medical services. Make referrals through supervisory channels.
  3. (ASU) Keeps Family Community Resource Center staff informed of any action taken as a result of a referral.
  4. (FCRC) Refer medical providers requesting forms to the HFS Bureau of Comprehensive Health Services (BCHS), Provider Participation Unit.
  5. (FCRC) Provide information about the medical program to clients, medical providers, and the public when requested.
  6. (BCHS) Helps providers in completing bills.
  7. (BCHS) Makes timely payment on bills correctly completed and submitted.
  8. (BCHS) Decide if Split Billing Transmittal for MANG (Form 2432) should have been sent to the provider to attach to the bill for a spenddown case. Form 2432 is needed if covered services were provided on the date of beginning medical eligibility (see PM 15-08-10 and WAG 15-08-10).
  9. (FCRC) Reviews a medical bill, when asked by a client who is being threatened about payment and the client believes the bill should have been paid by HFS.
  10. (FCRC) Tell a client who asks for a review of a medical bill to call the DHS Helpline at 1-800-843-6154.
  11. (System) Issues Summary of Past Medical Eligibility (Form 3690C) to the client when Form 157 is sent to report the end of Medicaid eligibility. This form shows Medicaid coverage for up to 24 months before the last day of Medicaid eligibility.

Form 3690C helps a person prove prior health coverage when Medicaid ends and they then apply for private or group health insurance coverage. This proof is used to reduce or eliminate any waiting period that may be imposed because of a preexisting condition.

When Medicaid coverage ends, Form 3690C is sent the week following the actual last day of the client's eligibility. Refer calls about Form 3690C to:

Illinois Department of Healthcare and Family Services
P.O. Box 19120
Springfield, IL 62794-9120
1-888-281-8497 (TTY: 1-866-324-3854)