HFS Provider Notice : Improper Submission of the CMS 1500, Health Insurance Claim Form

HFS Provider Notice Issued 10/05/2018

Date:  October 5, 2018     
To:     All Medical Assistance Program Providers
Re:     Improper Submission of the CMS 1500, Health Insurance Claim Form
This notice is a reminder that if providers choose to bill paper claim forms, only HFS proprietary paper claim forms are to be submitted for billing Medicaid non-institutional services or supplies. This applies to claims for participants who are covered under fee-for-service Medicaid and are notenrolled in a HealthChoice Illinois managed care plan. Providers should refer to the applicable plan for managed care billing guidelines.
The Department cannot process the CMS 1500 claim form. Due to the volume of CMS 1500 forms that the Department receives, staff is unable to return them to providers. Providers will not be able to determine a claim status for a service submitted on a CMS 1500.
HFS strongly encourages providers to bill the Department electronically using the Medical Electronic Data Interchange Internet Electronic Claims (MEDI IEC) System. However, if providers must submit paper forms, the attachment to this notice identifies the appropriate paper forms to be used by non-institutional providers when billing for services rendered and/or equipment supplied to HFS participants. Paper claim forms may be ordered from the Department’s website.
More specific billing guidance is contained in Provider Handbooks that are located on the Department’s website. The appendices contain billing and mailing instructions for the specific HFS proprietary paper claim form to be used by the provider.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Teresa T. Hursey
Medicaid Director


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