Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 140 - MEDICAL PAYMENT
Subpart B - MEDICAL PROVIDER PARTICIPATION
Section 140.43 - Post Approval for Items or Services When Prior Approval Cannot Be Obtained
Universal Citation: 89 IL Admin Code ยง 140.43
Current through Register Vol. 48, No. 38, September 20, 2024
a) Post approval may be requested for items or services provided during Department nonworking hours, or nonworking hours of its agents, whichever is applicable, or when a life threatening condition exists and there is no time to call for approval.
b) To be eligible for approval consideration, the requirements for prior approval must be met and post approval requests must be received by the Department or its agents, whichever is applicable, no later than 90 days after the date services or goods are provided. Exceptions to this requirement will be permitted only in the following circumstances:
1) The Department or
the Department of Human Services has received the patient's Medical Assistance
application, but approval of the application has not been issued, as of the
date of service. In such a case, the post approval request must be received no
later than 90 days after the date of the Department's Notice of Decision,
approving the patient's application.
2) The patient did not inform the provider of
his/her eligibility for Medical Assistance. In such a case, the post approval
request must be received no later than six months after the date of service,
but will be considered for payment only if there is attached to the request a
copy of the provider's dated, private pay bill or collection correspondence,
which was addressed and mailed to the patient each month following the date of
service.
3) A request for payment
was submitted to a third party billing within six months following the date of
service. In such a case, a post approval request must be received by the
Department no later than 90 days after the date of final adjudication by the
third party.
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