Encounter Submission Manual

​The Encounter Submission Manual is a resource to support IL Medicaid managed care organizations (MCOs) in reaching optimal encounter claims submission to the Illinois Department of Healthcare and Family Services (HFS).

• Chapter 1:  Overview

• Chapter 2:  Encounter Adjudication Process

• Chapter 3:  Encounter Submission Guidelines

• Chapter 4:  Resources

• Chapter 5:  Error Resolution

• Chapter 6:  File Layouts

• Appendix A:  Encounter Claim Crosswalks

• Appendix B:  Encounter Error Resolution
  The following Error Resolution Document were constructed from the encounter rejection error codes for the encounter claims that were submitted by IL Medicaid MCOs and rejected by the Illinois Medicaid claims adjudication software application (known as the Medicaid Management Information System, or MMIS).  It is possible that there are other error codes that have not occurred by the submission of the encounter claims and therefore would not be present on this document.  Before using the Error Resolution Document, the "ReadMe" section must first be read carefully.  The Error Resolution Document is to be treated as tools for improving MCO encounter submissions.  If there is a discrepancy between this Error Resolution Document versus the MMIS, the MMIS is correct.