TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.23 PAYMENT OF CLAIMS


 

Section 140.23  Payment Of Claims

 

a)         The Department shall pay only for those services and supplies that:

 

1)         Meet the U.S. Department of Health, Education and Welfare's definition of medical service, (42 U.S.C. 1396d),

 

2)         Can be paid by vendor payment, and

 

3)         Are specified in the individual rules governing particular types of medical services provided.

 

b)         Except as provided in Paragraph (d), the Department shall make payment only after services have been rendered.

 

c)         Payment shall be made only to a provider who

 

1)         Participates in the Medical Assistance Program, and

 

2)         Except as provided in Paragraph (d), is the actual provider of service.

 

d)         The Department may contract with qualified practitioners, hospitals and all other dispensers of medical services for the provision and reimbursement as specified in the contract of any and all medical care or services on a prepaid capitation, volume purchase, ambulatory visit or per discharge basis.  Such contracts shall be based either on formally solicited competitive bid proposals or individually negotiated rates with providers willing to enter into special contractual arrangements with the State.  Payments shall be made in advance of services under prepaid capitation arrangements.  The Department shall not pay a provider for services provided to recipient enrolled in a HMO or other plan as specified above when the service is one which the HMO or plan has contracted to provide.

 

(Source:  Amended at 8 Ill. Reg. 6785, effective April 27, 1984)