Third-Party Billing

Third-Party (or health care) billing is the process of charging public and private insurance/health plans for the purpose of reimbursing services rendered by a healthcare provider. While local health departments (LHDs), community-based organizations (CBOs), and other healthcare providers (HCPs) are some of the most common providers of public health services, many of them have not developed capacity to bill public or private payers/health plans.

Healthcare providers need to maximize revenue capture to sustain their organizations and to continue to provide essential public health services in an era of dwindling public funding. Public health providers often offer safety net coverage:  ensuring that low-income clients, many newly insured under the Affordable Care Act (ACA)/expanded Medicaid, have access to public health services.

The Illinois Public Health Association (IPHA) has a long, successful history in assisting local health departments, community-based organizations, and other healthcare providers with implementing the six core components of third-party billing:

• credentialing
• contracting
• coding
• billing
• electronic medical records implementation
• revenue cycle management

IPHA's technical assistance has resulted in the generation of more than $40 million in new revenue for essential public health services in Illinois over the past decade.  In 2020, the IPHA Third-Party Billing project was recognized as a Billing Project Success Story by the Centers for Disease Control and Prevention (CDC).  CDC funded 38 projects nationwide and only six projects received this recognition.  

For more information on Healthcare Billing, please contact Phil Talley, Business Development and Billing Project Manager.

Community Based Organization (CBO) Clinical Services Expansion Playbook

 The Illinois Public Health Association has teamed up with Medical Revenue Cycle Specialists (MRCS) to create this free playbook to help community-based organizations (CBOs) through the often time-consuming and cumbersome process of establishing third-party billing processes. Funding for the playbook comes from the Illinois Department of Public Health (IDPH).

With the implementation of Illinois’ 1115 Waiver, CBOs will play a vital role in providing essential healthcare services to underserved populations. Currently, many services provided by CBOs are funded by government or private sector grants.  Most CBOs do not have the capacity to bill third-party payers such as Medicaid, Medicare, and private insurance, usually due to a lack of internal knowledge or funding to invest in software and training. The playbook provides a valuable guide to help CBOs implement third-party billing and revenue cycle management (RCM) procedures.

The information in the playbook is built specifically for the needs of CBOs based on a series of one-on-one consulting sessions with Illinois-based CBOs. Some of the topics covered include provider credentialing, payer contracting, medical coding, fee schedules, and more. IPHA is proud to provide this valuable resource to help CBOs become less dependent on grant funding, more self-sufficient, and enhance their capacity to provide affordable healthcare services to the communities they serve.

IPHA CBO Playbook

Medicaid Enrollment and Billing Guide for Lactation Professionals

This Billing Guide was designed to support lactation professionals in navigating the process of becoming enrolled Medicaid providers. This guide is presented in the order you will need to complete each step, from enrollment to initial billing setup. We strongly encourage you to read the entire document before beginning the process, as each stage builds on the last and includes tips that may save time and prevent common setbacks.

Billing Guide

Third-Party Billing Webinars

IPHA is excited to share our Learning Management System, IPHA Academy. The recordings and slides of past Third-Party Billing webinars can now be found on IPHA Academy. You can create a free account and view the past webinars along with other public health education content. Some recent Third-Party Billing webinar topics include: Meridian Billing Success for Local Health Departments, Understanding New Medicaid Coverage for Lactation Services in Illinois, and Reinforcing Your Community's Safety. 

Third-Party Billing Digests

Third-Party Billing Regional Forums

During the month of April 2025, IPHA’s Third-Party Billing Team hosted three regional meetings to provide information about billing and revenue cycle management (RCM) resources available to health departments and community-based organizations.

• Central Illinois – April 3, 9:00 AM – 1:30 PM, at the Peoria City/County Health Department, 2116 N. Sheridan Road, Peoria, IL
• Southern Illinois – April 9, 10:00 AM – 2:00 PM, at the Rolland Community Building, 800 S. 27^th Street, Mt. Vernon, IL (This meeting was held in conjunction with Southern IL Public Health Consortium’s Bookkeepers’ meeting)
• Northern Illinois – April 17, 9:00 AM – 1:30 PM, at the Will County Health Department and Community Center, 501 Ella Avenue, Joliet, IL

These forums were facilitated with funding from IPHA’s Third-Party Billing contract with the Illinois Department of Public Health (IDPH). Each forum gathered a mix of providers, partners, and payers for open conversations, training, and networking. One of the highlights for attendees was hearing directly from Illinois’ Medicaid managed care organizations (MCOs). Providers had the chance to meet MCO representatives face-to-face, ask questions, and gain a better understanding of each MCO’s procedures and resources.

Billing and RCM trainings were provided by the following guest speakers:

• Emily Hendrickson, RN, MSN, Director of Nursing for Adams County Health Department and President of Illinois Public Health Administrators, presented at the forum in Peoria on April 3.
• Meredith Vogel-Thomas, RMA, Office & Billing Manager, Morgan County Health Department, presented at the forum in Mt. Vernon on April 9.
• Adriana Milan, MPA, SHRM-SCP, Director of Administrative Services, DeKalb County Health Department, presented at the forum in Joliet on April 17.
• The team from CDP, Inc. and ezEMRx; MikePeth, Siri Kumar, and Devang Patel, presented at the meetings in Peoria and Joliet.

Below are links to the information that was provided by each MCO and the guest speakers: