Form Hfs 1517 – Fill Out and Use This PDF

The HFS 1517 form is a pivotal document for healthcare providers in Illinois, facilitating the streamlined submission of various types of claims and requests to the Illinois Department of Healthcare and Family Services. It supports both electronic and fax submissions for a wide range of services, including medication invoicing, prior approval requests, and transportation invoicing, among others. For those looking to simplify their submission process and ensure efficient handling of their healthcare claims and requests, clicking the button below to fill out the HFS 1517 form is the first step.

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Form Hfs 1517 PDF Details

The Illinois Department of Healthcare and Family Services is a critical junction for medical providers within the state, chiefly concerning the submission and management of various healthcare-related claims and requests. The HFS 1517 form emerges as a vital document in this bureaucratic yet essential landscape, serving as a comprehensive request form for providers seeking different types of healthcare forms. Designed to streamline the order process, it covers a wide array of documents, from drug invoices and Medicare crossover forms to transportation and medical equipment invoices. The form provides an evident reflection of the department's effort to adapt to the digital age, promoting the use of online submissions through the Medical Electronic Data Interchange and Internet Electronic Claims system – a significant leap aimed at enhancing efficiency through technological solutions. Equally important is the detail-oriented approach the form adopts, requiring specific information such as provider Medicaid numbers, addresses, and intended quantities, thus ensuring precision in form delivery and handling. Its facilitation of both physical and electronic submissions addresses varied provider preferences, marking a thoughtful effort towards accessibility and convenience in the realm of healthcare administration.

Question	Answer
Form Name	Form Hfs 1517
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	hfs1517 il478 form

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Illinois Department of Healthcare and Family Services

2946 Old Rochester Road

Springfield, Illinois 62703-5659

Online Forms Request: http://www.hfs.illinois.gov/forms/

Fax Number: (217) 557-3459

Please note that claims may be submitted through the department’s Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System at: http://www.myhfs.illinois.gov This electronic feature allows providers to submit claims directly to the department through Internet browser software with no additional hardware or software.

PROVIDER FORMS REQUEST

TYPE OR PRINT ALL ENTRIES

ORDER REQUEST DATE: ______________________ PROVIDER MEDICAID NUMBER: _____________________________

PROVIDER NAME: _______________________________________________________

STREET ADDRESS: ______________________________________________________ (CANNOT DELIVER TO POST OFFICE BOX)

CITY/STATE/ZIP: ________________________________ PHONE #: (_____) _____ -_______ ATTENTION OF: _____________________

PROVIDER E-MAIL ADDRESS: __________________________________ (Optional)

Enter the quantity of the forms being requested in increments of 100. Please be sure to indicate the total number of individual forms or envelopes needed in the Quantity column, not the number of boxes, cases or packages.

HFS Form Number:		QUANTITY:	Envelope Number:		QUANTITY:
215CF Drug Invoice, (Continuous Feed Format)		__________	824MCR Medicare Crossover		__________
1409	Prior Approval Request	__________	1414	Special Approval	__________
1443	Provider Invoice, (Single Sheet)	__________	1415	Drug Invoice	__________
1443CF Provider Invoice, (Continuous Feed Format)		__________	1416	Adjustments	__________
2209	Transportation Invoice, (Single Sheet)	__________	1444	Provider Invoice Envelope	__________
2209CF Transportation Invoice, (Continuous Feed Format)		__________	2244	Transportation Invoice	__________
2210	Medical Equipment / Supplies Invoice, (Single Sheet)	__________	2246	Health Agency Invoice	__________
2210CF Medical Equipment / Supplies Invoice, (Cont. Feed Format) __________			2247	Medical Equipment Supplies	__________
2211	Laboratory / Portable X-Ray Invoice, (Single Sheet)	__________	2248	NIPS Special Invoice Handling	__________
2211CF Laboratory / Portable X-Ray Invoice, (Cont. Feed Format)		__________	2294	Equip/Supplies Prior Approval	__________
2212	Health Agency Invoice, (Single Sheet)	__________	2300	Prior Approval Request	__________
2212CF Health Agency Invoice, (Continuous Feed Format)		__________	Additional Forms Needed, Not Listed Above:
2360	Health Insurance Claim Form, (Single Sheet)	__________	__________________________		__________
2360CF Health Insurance Claim Form, (Continuous Feed Format)		__________	__________________________		__________
3797	Medicare Crossover Invoice (Single Sheet)	__________	__________________________		__________
3797CF Medicare Crossover Invoice, (Continuous Feed Format)		__________	__________________________		__________

Submit this form by fax or mail to the address listed above.

HFS 1517 (R-9-10)

IL478-1023

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Form Hfs 1517 – Fill Out and Use This PDF

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