FAQs About PAs and Illinois Medicaid


PLEASE NOTE: the following information is provided for educational purposes and should not be considered as legal advice.

General PA FAQs

 

Can a PA be reimbursed for services provided to a Medicaid patient?

YES.

A-202 Practitioner Reimbursement (Found in the HFS Provider Handbook) / A-202.1 Charges
Practitioners are to submit charges to the department only after services have been rendered. Charges are to be the practitioner‘s usual and customary charges to the general public for the services provided. To be paid for services, all claims, including claims that are re-billed, must be received within one (1) year of the date of service. The department must receive a claim after disposition by Medicare, or its fiscal intermediary, no later than twenty-four (24) months from the date of service.

A practitioner may charge only for services personally provided, or which are provided under direct supervision in the practitioner’s offices by ancillary licensed or certified staff, e.g., laboratory tests done by a technician in the practitioner’s employ.

A practitioner may not charge for services provided outside the practitioner’s office by anyone other than the practitioner.

Exception: A physician may submit a bill for services provided by a non-enrolled Advanced Practice Nurse (APN), a Physician Assistant (PA) or a Genetic Counselor, as long as such practice is in accordance with the policy outlined in this handbook or not in conflict with the following rules and regulations:

  • Nurse Practice Act (225 ILCS 65)
  • Physician Assistant Practice Act (225 ILCS 95)
  • Genetic Counselor Licensing Act (225 ILCS 135)
  • Department of Professional Regulations rules for administration of Physician Assistant Practice Act (68 Ill. Adm. Code 1350)
  • Department of Professional Regulations rules for administration of Nursing and Advanced Practice Nursing Act – Advanced Practice Nurse (68 Ill. Adm. Code 1305)
  • HFS rules for Advanced Practice Nurses (89 Ill. Adm. Code 140)

A practitioner may not charge for services provided by another practitioner even though one may be in the employ of the other.

Can PAs see Medicaid Patients?

Yes. PAs can see all Medicaid patients including new patients.

Can PAs bill for Medicaid patients?

Yes. PAs need to submit claims with their supervising/collaborating physician listed as the “billing provider” and the PA listed as the “rendering provider.”