Section 140.20  Submittal of Claims

a)         When claims for payment are submitted to the Department, providers shall:

1)         Use Department designated billing forms or electronic format for submittal of charges, and

2)         Certify that:

A)        They have personally rendered the services and provided the items for which charges are being made,

B)        Payment has not been received, or that only partial payment has been received,

C)        The charge made for each item constitutes the complete charge,

D)        They have not, and will not, accept additional payment for any item from any person or persons, and

E)         They will not make additional charges to, nor  accept additional payment from, any persons if the charges they present are reduced by the Department to conform to Department standards.

b)         Statement of Certification

1)         All billing statements shall contain a certification statement that must remain unaltered, and must be legibly signed and dated in ink by the provider, his or her designated alternate payee, or his or her authorized representative.  A rubber stamp or facsimile signature is not acceptable.

2)         An "authorized representative" may only be a trusted employee over whom the provider has direct supervision on a daily basis and who is personally responsible on a daily basis to the provider.  Such representative must be specifically designated and must sign the provider's name and his or her own initials on each certification statement.

3)         An alternate payee must be specifically designated by the provider and must sign the provider's name and alternate payee's authorized representative's initials on each certification statement.

c)         To be eligible for payment consideration, a provider's vendor-payment claim or bill, either as an initial or resubmitted claim following prior rejection, must be received by the Department, or its fiscal intermediary, no later than 12 months after the date on which medical goods or services were provided, with the following exception. The Department must receive a claim after disposition by Medicare or its fiscal intermediary no later than 24 months after the date on which medical goods or services were provided.

d)         Claims that are not submitted and received in compliance with the foregoing requirements will not be eligible for payment under the Department's Medical Assistance Program, and the State shall have no liability for payment of the claim.

(Source:  Amended at 31 Ill. Reg. 2413, effective January 19, 2007)