Illinois Administrative Code
Title 8 - AGRICULTURE AND ANIMALS
Part 755 - PAYMENT OF ELIGIBLE CLAIMS OF SOIL AND WATER CONSERVATION DISTRICT EMPLOYEES UNPAID BY MID-CONTINENT MEDICAL BENEFIT TRUST
Section 755.40 - Procedures for Requesting Payment of Outstanding Costs
Universal Citation: 8 IL Admin Code ยง 755.40
Current through Register Vol. 48, No. 12, March 22, 2024
a) Employees shall submit claims on forms provided by the Department. Employees shall provide documentation of:
1) their policy's deductible amount and the
amount of any payments applied toward it;
2) the name, address, and telephone number of
each provider for which outstanding costs are claimed;
3) all outstanding costs claimed, including
the date of service, patient account number, services provided and charges
assessed;
4) all payments made to
providers or collection agencies against outstanding costs and the source of
those payments; for example, the employee, secondary insurers, the Districts,
other persons, etc.; and
5) the
amount of eligible costs, if any, which have been forgiven by the
provider.
b) Documentation acceptable to the Department shall include, but is not limited to, original provider bills, canceled checks, payment receipts, balance due statements, statements of benefits from Mid-Continent, and correspondence from providers, Mid-Continent or other relevant sources.
Disclaimer: These regulations may not be the most recent version. Illinois may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
