Illinois Medicaid: LTSS

A healthcare professional and an elderly patient hold hands

FRAUD ALERT: Please remind your patients with Medicaid coverage that Illinois will never ask for money to renew or apply for Medicaid. If they receive a request to pay to renew or apply for Medicaid, please ask them to report the scam on the fraud report website or call the Medicaid fraud hotline at 844-ILFRAUD (453-7283).

Long-term services and supports (LTSS)

Long-term services and supports provider orientation and education

Humana claim-payment inquiry resolution guide

To simplify claim payment inquiries, Humana has worked to clarify its process and to ensure that you have the support you need. Refer to the below document to learn more.

Humana claim-payment inquiry resolution guide

Humana made several important updates to our claim processing procedures to enhance efficiency, improve accuracy and ensure you are paid faster. These improvements include an integration of advanced automation technologies, which should reduce processing times and minimize potential errors. The following list details implemented updates:

Claim issue	Description of issue	Affected provider type	Call to action
Supportive living facility claims billed per the days (DA) option	Claims submitted using the DA option currently are not being processed for revenue code 240.	Supportive living facility	Provider should rebill a corrected claim using the UN (unit) option for any denied claims. Provider should submit a new electronic claim, submission initial claims using the units option.
Services not allowed according to provider’s contract	Claims are denied (code 60C) when Leave of Absence codes are billed with revenue code 240 during the covered days.	Facility	Humana will correct the issue and reprocess claims as quickly as possible. Humana will notify providers when the issue is resolved.
Multiple months accepted for homemaker services (S5130)	Homemaker services (code S5130) claims are denied (code 338) in error when multiple months are billed on the same claim form.	Long-term services and supports (LTSS)—atypical	Humana will correct the issue and reprocess claims as quickly as possible. Providers should rebill corrected claims for separate months for any denied claims. For new claims/services, providers should bill 1 month per each claim.

Claim issue

Description of issue

Affected provider type

Call to action

Supportive living facility claims billed per the days (DA) option

Claims submitted using the DA option currently are not being processed for revenue code 240.

Supportive living facility

Provider should rebill a corrected claim using the UN (unit) option for any denied claims.

Provider should submit a new electronic claim, submission initial claims using the units option.

Services not allowed according to provider’s contract

Claims are denied (code 60C) when Leave of Absence codes are billed with revenue code 240 during the covered days.

Facility

Humana will correct the issue and reprocess claims as quickly as possible.

Humana will notify providers when the issue is resolved.

Multiple months accepted for homemaker services (S5130)

Homemaker services (code S5130) claims are denied (code 338) in error when multiple months are billed on the same claim form.

Long-term services and supports (LTSS)—atypical

Humana will correct the issue and reprocess claims as quickly as possible.

Providers should rebill corrected claims for separate months for any denied claims.

For new claims/services, providers should bill 1 month per each claim.

Provider Documents

Long-Term Services and Supports (LTSS) Provider Billing Guide

Long-Term Service and Supports (LTSS) Provider Resource Guide

Illinois Medicaid

Illinois Medicaid
Illinois Medicaid Provider Notices and Updates
Illinois Medicaid Provider Documents
Illinois Medicaid Provider Training Materials
Illinois Medicaid Provider Long-Term Services & Support