initial invoice was submitted, Claimant had not previously forwarded a copy of its private-pay charges to IDPA’s local office for adjudication of Ford’s September 1990 spenddown obligation, as required (Handbook f o r Hospi- . tals, Topics 105 and H-214.2). As a result, Fords MAP eligibility during September 1990 had not been estab- lished; and Claimant had not received a Split Billing Transmittal (DPA form 2432) from the local office, to submit with its invoice as verification that Ford’s Septem- ber spenddown obligation had been “met.” (See S t . Anthony Hospital Medical Center v. State (1991), 44 Ill. Ct. C1. 98.) Further, although Claimant’s “10-19-90” invoice had designated these, by the cotde used, as outpa- tient services-all performed on “09-12-90,” the invoice included charges for surgical and medical procedures reportedly performed on “09-13” and “09-14” as well as “09-12.” IDPA cited these deficiencies and inconsisten- cies in its December 4, 1990 notice, which refused pay- ment of this invoice; and the record here shows that Claimant had not remedied these problems by submitting a corrected rebill-invoice of its charges for Fords services by September 16, 1991, as required by IDPA Rule 140.20. Respondent further asserts that, under subsection (1)of PAC section 11-13, the Court lacked jurisdiction to entertain the claim for patient Kirby’s services as of June 26, 1992, when that claim
Case summary
The claimant hospital sought payment for medical services provided to a patient, but the court denied the claim because the claimant failed to comply with IDPA procedures, including submitting a corrected rebill-invoice by the required deadline.
Cases cited: St. Anthony Hospital Medical Center v. State (1991), 44 Ill. Ct. Cl. 98
AI-generated summary from the opinion text — may contain errors. The opinion text and PDF above are the official record.
initial invoice was submitted, Claimant had not previously forwarded a copy of its private-pay charges to IDPA’s local office for adjudication of Ford’s September 1990 spenddown obligation, as required (Handbook for Hospi- . tals, Topics 105 and H-214.2). As a result, Fords MAP eligibility during September 1990 had not been established; and Claimant had not received a Split Billing Transmittal (DPA form 2432) from the local office, to submit with its invoice as verification that Ford’s September spenddown obligation had been “met.” (See S t .
Anthony Hospital Medical Center v. State (1991), 44 Ill.
Ct. C1. 98.) Further, although Claimant’s “10-19-90” invoice had designated these, by the cotde used, as outpatient services-all performed on “09-12-90,” the invoice included charges for surgical and medical procedures reportedly performed on “09-13” and “09-14” as well as “09-12.” IDPA cited these deficiencies and inconsistencies in its December 4, 1990 notice, which refused payment of this invoice; and the record here shows that Claimant had not remedied these problems by submitting [*375] a corrected rebill-invoice of its charges for Fords services by September 16, 1991, as required by IDPA Rule 140.20.
Respondent further asserts that, under subsection (1)of PAC section 11-13, the Court lacked jurisdiction to entertain the claim for patient Kirby’s services as of June 26, 1992, when that claim