Definition of a Visit

For consideration of payment by the Department, encounter clinic services must be provided by a clinic enrolled in the Department’s Medical Programs. The clinic must fall into one of the clinic categories described below.

• Federally Qualified Health Center (FQHC) – A health care provider that receives a grant under Section 330 of the Public Health Service Act (Public Law 78-410) (42 USC 1395x(aa)(3)) or has been determined to meet the requirements for receiving such a grant by the Health Resources and Service Administration, U.S. Department of Health and Human Services.

The Department is not to be billed for services if the participant is enrolled in a Managed Care Organization (MCO) or a Managed Care Community Network (MCCN).

A billable encounter is defined as one of the following:

• Medical face-to-face visit with a physician, physician assistant, or Advance Practice Nurse
• Behavioral health face-to-face visit with a licensed clinical psychologist, licensed clinical social worker, licensed clinical professional counselor, or licensed marriage and family therapist, as applicable
• Dental face-to-face visit with a dentist

SOURCE: IL Dept. of Healthcare and Family Services, Handbook for Providers of Encounter Clinic Services, Chapter D-200 Policy and Procedures for Encounter Clinic Services, p 5 & 16. (Aug 2016). (Accessed May 2025).

“Encounter Clinic” means a Federally Qualified Health Center, Rural Health Clinic or Encounter Rate Clinic, as defined in 89 Ill. Adm. Code 140.461.

SOURCE: IL Administrative Code 89 140.403 (3). (Accessed May 2025).