Illinois practices bill Medicare through National Government Services, Medicaid through HFS and the HealthChoice Illinois managed care plans, and a commercial market led by Blue Cross and Blue Shield of Illinois.
How Medical Billing Works in Illinois
Every state has its own mix of payers and rules, and Illinois is no exception. These are the points that most often decide whether a Illinois claim is paid on the first pass:
- Every Illinois Medicaid provider — including ordering and referring providers — must be enrolled in IMPACT, and missing enrollment is a frequent cause of rejected Medicaid claims.
- Most Illinois Medicaid members are in HealthChoice Illinois managed care plans (CountyCare is Cook County only), so the plan on the member's ID card decides where the claim goes.
- Blue Cross and Blue Shield of Illinois holds a large share of the commercial market, so its prior-authorization rules and claim edits have an outsized effect on cash flow.
Our Medical Billing Services in Illinois
We run the complete revenue cycle for Illinois practices, remotely and inside your existing EHR or practice management system:
- Insurance eligibility and benefits verification before each visit
- Medical coding (CPT, ICD-10-CM, HCPCS and modifiers) by certified coders
- Charge entry and claim scrubbing to catch errors before submission
- Electronic claim submission to Medicare, Illinois Medicaid plans and commercial payers
- Denial management and appeals with root-cause tracking
- A/R follow-up on aging claims, worked daily
- Payment posting from ERAs and EOBs, including underpayment checks
- Credentialing and payer enrollment, including IMPACT provider enrollment
- Monthly reporting on collections, denials and days in A/R
Who We Work With
Our Illinois clients include primary care and internal medicine practices, specialty groups such as rheumatology billing, ENT billing and hematology billing, independent laboratories and multi-location clinics. Whether you are in Chicago, Aurora or a smaller community, you get the same certified coders, the same daily A/R follow-up and the same transparent reporting.
Cities We Serve in Illinois
Specialties We Bill For in Illinois
Frequently Asked Questions
Who processes Medicare claims in Illinois?
Medicare Part B claims for Illinois are processed by National Government Services (NGS) (Jurisdiction 6 (J6)). We submit, track and follow up on those claims for you, including Medicare Advantage plans, which are billed to the private plan instead.
How do you bill Illinois Medicaid?
Illinois Medicaid is run by the Department of Healthcare and Family Services (HFS), and most members are enrolled in HealthChoice Illinois managed care plans such as CountyCare, Meridian and Blue Cross Community Health Plans. We verify the member's plan before the visit and send each claim to the right plan with the right edits.
Which commercial payers do you work with in Illinois?
We bill all major commercial payers in Illinois, including Blue Cross and Blue Shield of Illinois, UnitedHealthcare, Aetna, Cigna and Humana, plus regional and employer plans.
Which Illinois cities do you serve?
We serve practices throughout Illinois, with dedicated pages for Chicago, Aurora, Joliet, Naperville, Rockford, Springfield, Elgin, Peoria, Champaign and Waukegan. Because billing is done remotely, practices anywhere in the state can work with us.
How do we get started?
Request a free billing audit. We review a sample of your claims, denials and A/R, show you where revenue is being lost and give you a fixed quote — with no obligation.