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Shoreline Healthcare Technologies is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies in Illinois. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Illinois-based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Best In the Industry

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Shoreline Healthcare Technologies in Illinois exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

Illinois Billing Challenges we solve



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Handling Local Code + Special Modifier Rules

The State of Illinois uses a set of program-specific local modifiers and codes for certain public health and community-based services. This results in high rejection rates due to local Code Requirements as many EHR Software do not support these codes natively, causing high front-end rejections. We at Shoreline Healthcare Technologies have mapped all these local codes into our EHRs so they route correctly and applies the custom modifiers and county-based billing rules. Our software flags codes that require special documentation or certification. And helps providers to achieve 95% of First Pass Acceptance Rates.

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Managing the Long Lag in Medicaid/MCO Response Times

Illinois Medicaid MCOs have some of the slowest appeal turnarounds, medical review updates and Provider enrollment confirmations. Providers must wait for 60–90 days for an appeal response from certain plans, compared to 30–45 days in other states. We at Shoreline Healthcare Technologies push appeals rigorously and track every pending review with internal timers. Providers can achieve faster payments across all six major Illinois MCOs by partnering with us.

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Prior Authorization Rules that Change at a County Level

Some programs in Illinois operates through county public health structures, and hence certain PA rules differ regionally. For example, the Cook County often has slightly different requirements compared to rural counties and the CountyCare has unique PA lists. This creates an inconsistency for a centralized billing team. We at Shoreline have built a county-specific PA rule engine that assigns PA tasks to a centralized team. This helps Providers to stop dealing with surprise denials tied to mismatched county PA rules.

We at Shoreline Healthcare Technologies provide personalized support tailored to the unique needs of Illinois providers. Our team of experts understands the intricacies of the Illinois billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Comprehensive Medical Billing Services for Illinois

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Specialized Services tailored to meet Illinois Medicaid rules and regulations

🩺 Services 📍Illinois Specialization 📈 Typical Improvement ⏱️ Turnaround Time
End-to-End Medical Billing Tailored to meet the needs of HealthChoice Illinois, and all major MCOs and HFS Medicaid Programs 20–35% reduction in denials, faster payment cycles across multiple plans. Claim submission within 24–48 hours
Eligibility & Coverage Verification Real-time checks tailored for Illinois’s frequent redeterminations and mid-cycle coverage flips. 15–30% drop in eligibility-based denials Instant + daily auto-refresh
Prior Authorization Management County-specific PA rules updates 40–60% reduction in PA denials 3–5 business days for standard PAs
Denial Management AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions. Reduce rate of denial by 75% and with quicker appeals. 7–14 days for backlog cleanup; ongoing daily follow-up
Telehealth Billing Applies telehealth geography rules, specific codes, modifiers, and POS 25–40% fewer telehealth denials Same-day telehealth claim processing.
Patient Statements & Follow-Up Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options. Reduces overdue balances and better collection rates. 1-2 weeks
Audit & Compliance Support Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation. Minimizes risk of penalties and supports successful audits. Ongoing, depending on audit schedule

Medical Billing Resources for Illinois

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Comprehensive resources specifically designed for Medicaid Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering all billing requirements, policy updates and compliance standards.

Behavioral & Mental Health Billing rules and guidelines

Specialized billing guidelines and documentation procedures for behavioral health programs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Illinois

Illinois’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Illinois

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From Alexander to Williamson, we provide comprehensive medical billing services across all 102 Illinois counties.

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Northeast Illinois:

Chicago, DuPage, Kane, Lake, McHenry, Will, DeKalb, Grundy, Kankakee, Kendall, LaSalle

Northwest Illinois:

Boone, Bureau, Carroll, Henry, Jo Daviess, Lee, Marshall, Mercer, Ogle, Putnam, Rock Island, Stephenson, Whiteside, Winnebago

West Central Illinois:

Adams, Brown, Calhoun, Cass, Fulton, Hancock, Henderson, Knox, McDonough, Menard, Morgan, Peoria, Pike, Schuyler, Scott, Stark, Tazewell, Warren, Woodford

East Central Illinois:

Champaign, Coles, DeWitt, Douglas, Edgar, Ford, Iroquois, Livingston, McLean, Piatt, Vermilion

Central Illinois:

Christian, Logan, Macon, Macoupin, Mason, Montgomery, Moultrie, Sangamon, Shelby

Southwest Illinois:

Bond, Clinton, Jersey, Madison, Monroe, Randolph, St. Clair, Washington

Southeast Illinois:

Clark, Clay, Crawford, Cumberland, Effingham, Fayette, Jasper, Lawrence, Marion, Richland, Wabash, Wayne, White

Far South Illinois:

Alexander, Edwards, Franklin, Gallatin, Hamilton, Hardin, Jackson, Jefferson, Johnson, Massac, Perry, Pope, Pulaski, Saline, Union, Williamson

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Primary Care
Specialty Clinic
Rural Health
Mental Health
Cardiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Neurology
Oncology
Orthopedics
Pediatrics
Psychiatry
Radiology
Surgery
Urgent Care
Women's Health

Frequently Asked Questions

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FAQs about Medical Billing Services in Illinois

Q1. How can providers avoid denials caused by mid-month plan changes?

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Always re-verify the eligibility within 48 hours of the visit and again before claim submission. Monitor eligibility weekly for high-risk patients. We at Shoreline Healthcare Technologies use automated eligibility check that cross verifies against all MCO and prevent denials before they happen.

Q2. What is IMPACT enrollment and why does it matter for billing?

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IMPACT is the state’s provider enrollment and credentialing system. If the IMPACT data is wrong or inactive, all the Illinois Medicaid and MCO claims will get denied causing sudden drop in cash-flow.

Q3. Do PA rules differ between Illinois counties?

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Yes. Illinois is one of the few states that has county-specific PA rules, especially for behavioral health, therapy, and CountyCare members.

Q4. What is the timely filing limit for Medicaid claims in Illinois?

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HFS Fee-for-Service 180 days
Most MCOs 90–120 days
YouthCare 90 days

Q5. How can Shoreline Healthcare Technologies help providers in Illinois?

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We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules. We also offer analytics and process automation to reduce first pass rejects in state systems and to reconcile managed-care encounter reporting.

Compliance & Certifications

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Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

Illinois Licensed

Licensed to operate in Illinois

Medical Billing Glossary

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Essential Terms for Understanding the Illinois’s Medical Billing Landscape

HealthChoice Illinois

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The statewide Medicaid managed care program assigned to the members of Illinois (eg. Blue Cross, Meridian, Molina, Aetna, CountyCare, or YouthCare). Every plan has their own PA rules, coverage benefits, and billing processes.

Illinois Department of Healthcare and Family Services (HFS)

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HFS administers and manages the state’s Medicaid program. It takes care of the fee-for-service claims, provider enrollment rules, fee schedules, rate updates, and other administrative programs.

Illinois Medicaid Provider Advanced Cloud Technology (IMPACT)

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Illinois’ provider enrollment and credentialing portal. All Medicaid providers must enroll here. If your IMPACT status lapses or contains errors, all Medicaid and MCO claims will deny. This system connects to MCO rosters and determines whether a provider can be paid.

Medical Electronic Data Interchange (MEDI)

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The online portal where providers check for eligibility, claim status, remittance advice, for Medicaid services in Illinois. It is used as a primary tool to verify the active status of the Medicaid coverage.

Medical Technology Advisory Committee (MTAC)

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An advisory group to review the clinical evidences and make recommendations on coverage policies for certain procedures, technologies, and services. MTAC decisions help shape what Medicaid will approve or deny.

PointClickCare (PCC)

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The EHR platform used in Illinois for long-term care, skilled nursing, and post-acute settings. It is used to manage Medicaid documentation, care plans, and billing workflows for facilities.

Our Services

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Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

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Testimonials

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We Care

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From electronic health records, billing services and practice management tools – Shoreline has you covered! In addition to being an industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in Illinois understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

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Get your free consultation and discover how much you could save with our Illinois -specialized billing services.

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Contact Information

  • 445 Main Street, 2nd Floor, #1, Saco, ME 04072
  • 1-855-838-1370
  • info@shorelinemb.com
  • M-F, 9am - 5pm EST

Why work with us?
  • 40% average denial rate reduction
  • Local billing expertise
  • 24-48 hour claim turnaround
  • Dedicated Illinois support team