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How to submit claims/prior authorizations

Claims/Prior AuthorizationsSpecific billing/registration information:  Under the first 18 months of the program, until

SmartPlan Choice converts to a MCO or MCCN, you should continue to bill the Illinois Department of Healthcare and Family Services as Fee-for-Service for these services.

If services require prior approval in the fee-for-service system today, they will continue to require it under ACEs. The process of obtaining prior approval from the state remains unchanged.

The Department electronic eligibility systems will state “no MCO information for this inquiry” and will clearly identify the ACE in which an individual is enrolled under the ‘Accountable Care Entity segment.

The member ID # is also their Medicaid Recipient Identification Number (RIN) #, for reference.

 If you have any questions, please contact the SmartPlan Choice call center at 844.254.CARE (2273). 

Prior AuthorizationsType Contact

For durable medical equipment and supplies, occupational, physical and speech therapies, podiatric items and services, communication and prosthetic devices, or home health agency services, contact: 

Illinois Department of Healthcare and Family ServicesPrior Approval UnitPost Office Box 19124Springfield, Illinois 62794-91241-877-782-5565 select option 5 from the automated menuFAX # (217) 524-0099

For dental services which require prior approval, contact:

DentAQuest at: http://www.dentaquest.com/find-a-dentist-gov/ or via phone at 1-888-286-2447.

Prior Authorizations- DrugsPrior Authorizations Prior AuthorizationsFor drugs not included in the Department Drug Manual and Refill-Too-Soon override requests, check (http://ilpriorauth.com/) and then contact:

- Drug Prior Approval requests may be submitted using the following methods: 

- NCPDP D.0 electronic format P4 Prior Approval Request Only Transaction (pdf) 

- Fax to the Drug Prior Approval Hotline at 217-524-7264 or 217-524-0404

- Call the Drug Prior Approval hotline at 1-800-252-8942 - Directly data enter into the Drug Prior Approval/Refill 

Too Soon Entry System through the department’s Medical Electronic Data Interchange (MEDI) System

PHARMACIES ONLY –  Automated Voice Response System (AVRS) Available 24 hours, 7 days a week, including holidays – 1-800-642-7588.

Inpatient Reviews

EQ Health:

• Review Certification Line: 800.418.4033 (Monday-Friday 8 am to 5 pm, CST)

• Provider Helpline: 800.418.4045 (Monday-Friday 8 am to 5 pm, CST) or online eQSuite™

Instructions for prior authorizations for elective services: http://il.eqhs.org/PriorAuthResources/ProviderManual.aspx 

Faqs: http://il.eqhs.org/Portals/0/2014%20FAQs%20rev%20May%202014%20HFSOIG.pdf