MedicaidAdministrativeMedium impact
Lab Testing and Claim Submittal for Individuals in a Long-Term Care Facility
Illinois Medicaid - HFS·IL · Pathology·Provider Notice
Effective date
Mar 18, 2020
We identified it
Jun 20, 2026
Summary
Illinois updated billing guidelines for COVID-19 lab testing in long-term care facilities, effective March 18, 2020. The policy provides specific billing instructions based on patient insurance type (Medicaid, Medicare Part A/B, private insurance, uninsured) and requires labs to hold certain claims until new systems are implemented.
Action Required
Immediately: Labs billing COVID-19 testing for long-term care facility residents must follow specific billing hierarchy - bill Medicaid/managed care plans first, then Medicare Part B with C89/R36 override if needed. Hold fee-for-service claims for hospice patients and uninsured patients (dates of service March 18, 2020+) until HFS issues further guidance. Use HFS 2211 form for Medicare denials with EOB copy. Ensure enrollment in IMPACT system for Medicaid reimbursement.