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Illinois Medicaid Documentation Requirements

Retention of Records

Business and professional records must be maintained for a period of not less than six (6) years from the date of service or as otherwise provided by applicable state law, whichever period is longer, except that:

    • If an audit is initiated within the required retention period, the records must be retained until the audit is completed and every exception resolved.
    • Original signed billing certifications for every voucher received are to be retained not less than three years from the date of the voucher.

The provider's business and professional records for at least 12 previous calendar months shall be maintained and available for inspection by authorized Department personnel on the premises of the provider. Department personnel shall make requests in writing to inspect records more than 12 months old at least 2 days in advance of the date they must be produced.

Business Records

 Any and all business records that may indicate financial arrangements between the provider and other providers in the program or other entities, or that are necessary to determine compliance with federal and State requirements, including but not limited to:

    • Business ledgers of all transactions,
    • Records of all payments received, including cash,
    • Records of all payments made, including cash,
    • Corporate papers, including stock record books and minute books,
    • Records of all arrangements and payments related in any way to the leasing of real estate or personal property, including any equipment,
    • Records of all accounts receivable and payable;

Medical Records

Providers are to maintain any and all professional records which relate to the quality of care given by the provider or which document the care for which payment is claimed, including, but not limited to:

    • Medical records for applicants and participants in the Department’s Medical Programs (copies of claims alone will not meet this requirement), including a record of ancillary services ordered as a result of medical care rendered by the provider.
    • Other professional records required to be maintained by applicable federal or state law or regulation.

Professional records documenting the history, diagnosis, treatment services, etc., of a patient covered under one of HFS’ medical programs are to be made available to other health care providers who are treating or serving the patient, without charge and in a timely manner, when authorized by the patient in writing.

Citation

Ill. Admin. Code ยง 140.28 

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