X. Waiver Service Billing Guidance

Bills for services delivered by contracted providers, most professionals and certain other entities are transmitted to DHS electronically through a File Transfer Protocol (FTP) process. Bills and time sheets for Personal Support services provided by domestic employees are sent to and paid by a Fiscal/Employer Agents (F/F/EAs) under contract with DHS.The F/EAs transmits the paid bills to DHS through a FTP process.

  1. Reporting of Community Services (ROCS)

    Most providers and payees, including F/EAs, bill DHS for of waiver services using the fee-for-service billing software DHS provides free of charge, called the Reporting of Community Services (ROCS) system. Some providers use a functionally equivalent system of their own.

    The ROCS system contains individual case information, provider information and billing information, including the results of DHS bill processing. The ROCS Manual contains instructions on how to use the system. Please see ROCS software updates and information on our DHS web site.

    Providers or payees may request the free ROCS software by following these two steps:

    1. Complete the Provider Information Form (IL462-1246) form, and submit it to: 

      DHS - Division of Developmental Disabilities
      Medicaid Waiver Unit
      600 East Ash, Building 400, Mail Stop 3
      Springfield, IL 62703

      Fax: (217) 558-2799 

    2. Request the software from the Office of Management Information Services (MIS) contacts:

      Fax: (217) 524-0289 Telephone
      Phone:  (217) 785-9559

      E-mail: DHS.ROCS@illinois.gov  

      Providers can also contact MIS to receive ROCS technical assistance and ROCS basic agency software.

  2. Billing Submission Requirements

    Domestic employees submit time sheets directly to Avenues To Consumer and Employer Services (ACES$) and Public Partnerships Limited (PPL) according to their processing requirements.

    Bills from other providers and Fiscal/Employer Agents (F/EAs) are processed for payment weekly by DHS. The deadline for receipt of File Transfer Protocol (FTP) transmissions is 5:00 PM on Mondays. Files received after that date will be processed the following Monday.

    Bills for services delivered during a state fiscal year must be received, processed and accepted for payment by DHS before the end of the lapse period (typically early August) following the end of the state fiscal year for prompt payment. Providers may submit late bills to the Department and, if approved, then to the Illinois Court of Claims for payment.

    1. General Requirements for Using File Transfer Protocol (FTP)

      Providers use the ROCS software or their own software to report via File Transfer Protocol (FTP). The following providers are required to transmit bills via FTP:

      1. Agencies that have contracts with the DHS Division of Developmental Disabilities (except Adult Day Care).
      2. Payees that submit bills for eight or more individuals.
      3. ACES$ for bills for reimbursement for payments to domestic employees
    2. Paper Billing to DHS for Qualified Providers

      Providers, except domestic employees, that do not have the ROCS software and serve fewer than eight individuals may submit paper bills monthly to the DHS address below. Appendix 19 provides copies of the billing forms and instructions.

      DHS Reporting of Community Services (ROCS)

      100 South Grand Avenue East

      2nd Floor, Harris 1

      Springfield, Il 62762

      Note: New providers must include their telephone number and attach a copy of the IRS W-9 to the first paper bill submitted to expedite payment.

    3. Audit Trail Requirements

      The service provider is responsible for submitting complete and accurate billings and for maintaining appropriately detailed documentation and audit trail information. Service providers must maintain documentation on file for at least six years from the date of service to establish an audit trail. Audit trail documentation and notes are subject to review by state staff or their designees. Documentation includes:

      1. Residential attendance records that are completed daily on-site and specify whether or not the individual was present or, if absent, identify the type of bedhold.
      2. Day services attendance records must be completed daily on site and must include the number of hours each individual was actively involved in program activities during the day, start and end times, time out for lunch unless it is part of active programming, and any time spent not participating in program activities (such as a doctor's or therapist's appointment in the middle of the day). Day services cannot be billed at the same time that other waiver services (such as therapy, counseling, etc.) are being delivered and paid. See Appendices for sample recommended day program timesheets.
      3. For services billed and paid on an hourly basis other than day program (ISSA, service facilitation, behavior services, therapies and personal support), staff logs must include the number of hours and minutes provided and the date and time of services to each individual. Progress and other case or activity notes should also support the hours billed.
    4. Required Information When Submitting Bills

      Providers must provide the following information when submitting bills for payment (please note applicability to ROCS system and paper billing submissions):

      1. Social Security Number: Providers must use the correct individual Social Security Number (SSN) in the Reporting of Community Services (ROCS) system and on all paper bills. Independent Service Coordination (ISC) agencies must also transmit the correct SSN when they transmit assessment and eligibility determination information. The SSN used must match the SSN on the Medicaid Management Information System (MMIS). The DHS Family Community Resource Center caseworker maintains the MMIS.

        If the SSN in ROCS does not match MMIS, the provider must either do a Change Client ID in ROCS or work with the DHS Family Community Resource Center caseworker to correct the SSN in MMIS.

      2. Recipient Identification Number (RIN): Providers must enter the correct and current individual Recipient Identification Number (RIN) on the Reporting of Community Services (ROCS) client case information.
      3. Individual Name: Providers must enter the individual's name in ROCS exactly as it appears on the Medicaid card and enrollment in MMIS.

        PAS/ISSA agencies must also transmit the individual's correct name when they transmit assessment and determination information. The name must match MMIS exactly.

        If the name in ROCS does not match MMIS, the provider must either change the name in ROCS or work with the DHS Family Community Resource Center caseworker to correct the name in MMIS.

        If the Social Security Number and Recipient Identification Number are not identical and correct in all databases, or if the name is different on ROCS and MMIS, the provider will not be paid for covered waiver services.

    5. Payee and Alternate Payee Information

      The individual service providers (except domestic employees who are paid by F/EAs may designate an alternate payee to receive the payment or may choose to receive the payment directly from the state, consistent with federal and state Medicaid requirements as set out in 89 Ill. Adm. Code 140.24.

      The individual service provider must not designate the individual or the individual's guardian or family as the payee. Doing so is contrary to Medicaid requirements and may have tax consequences for the individual, guardian or family.

      To designate an alternate payee, the service provider must complete and submit Payee Designation/ Authorization Form, signed by the provider and by the alternate payee and covering the dates of the services. This form must be renewed at the start of each state fiscal year.

      The service provider must mail completed Payee Designation/Authorization Forms to the address below:

      DHS - Division of Developmental Disabilities
      Medicaid Waiver Unit
      600 East Ash, Building 400, 3rd Floor
      Springfield, IL62703

      Fax: (217) 558-2799

      Only a formally designated payee may submit bills for another service provider, except the fiscal employer agent will pay and transmit claims on behalf of domestic employees.

      All payees must be established with DHS and the Office of the Comptroller. See Appendix 13 for required form, Request for Taxpayer Identification and Certification (IRS W-9), and instructions.

      Service providers that do not wish to receive payment directly from the State do not need to complete an IRS-W-9.

      For domestic employees, the fiscal employer agent (ACES$) will issue a W-2 at the end of each calendar year. For other providers or payees who require one, the State will issue an IRS-1099, miscellaneous income form, at the end of each calendar year.

    6. Billing Guidance by Service Type