Ill. Admin. Code tit. 50, § 2908.80 - Communication Between Health Care Providers and Payers
a) Any communication between the health care
provider and the payer related to medical bill processing shall be of
sufficient specific detail to allow the responder to easily identify the
information required to resolve the issue or question related to the medical
bill. Generic statements that simply state a conclusion, including, but not
limited to, "payer improperly reduced the bill" or "health care provider did
not document" or other similar phrases with no further description of the
factual basis for the sender's position, do not satisfy the requirements of
this Section.
b) The payer's
utilization of the Claim Adjustment Group Codes, Claim Adjustment Reason Codes,
and/or the Remittance Advice Remark Codes, or as appropriate, the NCPDP
Reject/Payment Codes, specified in Section
2908.60(e)(3),
when communicating with the health care provider or its agent or assignee
through the use of the 835 transaction, provides a standard mechanism to
communicate issues associated with the medical bill.
c) Communication between the health care
provider and payer related to medical bill processing shall be made by
telephone or secured electronic transmission unless the information cannot be
sent by those media, in which case the sender shall send the information by
first class mail or personal delivery.
Notes
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