MedicaidAdministrativeMedium impact
UPDATE: New Sections Published under the Comprehensive Billing Guide for Medicaid Managed Care Services
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Feb 9, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid Managed Care Organizations published Version 21 of their Comprehensive Billing Guide with multiple updates including changes to encounter rate clinic place of service requirements, orthotic/prosthetic billing quantity limits, inpatient LARC billing guidance, and various MCO-specific policy updates. This creates a single source for MCO billing requirements across all contracted providers.
Action Required
Immediately: Billing team should review Version 21 of the IAMHP Comprehensive Billing Guide on the IAMHP website. Update billing procedures for encounter rate clinics to comply with new place of service requirements. Review and adjust quantity limits for custom orthotic, prosthetic and pedorthic services billing. Update inpatient hospital billing workflows for long-acting reversible contraceptives (LARCs). Contact IAMHP for questions about the guide or individual MCO plans for specific policy clarifications.