Section 123.350  Provider Reimbursement

a)         Providers enrolled with the Department to participate pursuant to 89 Ill. Adm. Code 140.11 and 140.12 may participate under this Part.

b)         Provider participation under this Part shall be voluntary.

c)         Providers under this Part shall be reimbursed in accordance with the established rates of the Department or other appropriate State agency as set forth in 89 Ill. Adm. Code 140, 143, 144, 148, 149, 152, and 153; 52 Ill. Adm. Code 132; and 77 Ill. Adm. Code 2090 minus co-payments or cost sharing as specified in Section 123.320(b)(1), (3), (4), (5) and (6), regardless of whether the patient share is collected.  Co-payments or cost sharing specified in Section 123.320(b)(3), (4) and (5) will not be deducted once the child has reached the out-of-pocket cost sharing limit specified in Section 123.320(c).

d)         Providers under this Part shall be prohibited from billing children covered under the All Kids Premium Levels 2-8 any difference between the charge amount and the amount paid by the Department other than the co-payment and cost sharing amounts specified in Section 123.320.

e)         Providers shall be responsible for refunding to the family co-payments and cost sharing collected in excess of the amounts permitted by this Part.

f)         The Department shall make available an electronic system by means of which a provider may verify a specific child's eligibility under the program, and the amount of co-payments that may be charged as set forth in Section 123.320.