Illinois Payer Configuration and Requirements Tables
The payer configuration table is a valuable resource to help you understand the specific requirements for each payer contract as they relate to the integration process. By referencing this table, you can ensure the correct configuration of payer contracts, maintain compliance, and streamline workflows. Use this topic as a quick reference to verify the scope of each payer’s requirements and to facilitate a smooth integration process.
IL Division Of Developmental Disabilities (DDD)
| Payer | IL Division Of Developmental Disabilities (DDD) |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
IL Division of Specialized Care for Children (DCSS)
| Payer | IL Division of Specialized Care for Children (DCSS) |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
IL Dept of Healthcare & Family Services
| Payer | IL Dept of Healthcare & Family Services |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Department of Aging (DRS)
| Payer | Department of Aging (DRS) |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 300ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Aetna Better Health of Illinois
| Payer | Aetna Better Health of Illinois |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Aetna MMAI
| Payer | Aetna MMAI |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
IL Blue Cross Blue Shield HCI & MMAI
| Payer | IL Blue Cross Blue Shield HCI & MMAI |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
CountyCare Health Plan IL HCI
| Payer | CountyCare Health Plan IL HCI |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Meridian Health Plan of IL
| Payer | Meridian Health Plan of IL |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Molina Healthcare IL HCA & MMAI
| Payer | Molina Healthcare IL HCA & MMAI |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |
Humana IL MMAI
| Payer | Humana IL MMAI |
|---|---|
| 835s Availability | Not in Scope |
| Billing Required | Not Required |
| Communications Module Availability | Not Available |
| DX Code Provider/Payer Managed | Not Required |
| EVV Required | Required |
| Payer GPS Tolerance | 500ft |
| Missed Visits Required | Required |
| POC Compliance Required | Not Required |
| Rate Provider/Payer Managed | Provider Managed |
| Referring Physician Required | Not in Scope |