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Health Financial Systems REVIEW SPECIALTY HOST & REHAB In Lieu of Form CMS255210 This report is required by law (42 USC 1395g; 42 CFR 413.20(b)). Failure to report can result in all interim FORM APPROVED

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Healthcare providers and medical professionals in Illinois who need to submit financial information or claims to the Illinois Department of Healthcare and Family Services (HFS) through the health financial systems (www2.illinois.gov/hfs/medicalproviders/health financial systems) platform.

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The www2illinoisgovhfsmedicalprovidershealth financial systems is in Illinois.

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