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Elizabeth M. Whitehorn, Director

Appendix A: Encounter Claims Crosswalks

The following crosswalks were constructed from encounter claims that were submitted by IL Medicaid MCOs and accepted by the Illinois Medicaid claims adjudication software application (known as the Medicaid Management Information System, or MMIS).  It is possible that there are valid instances that have not yet been submitted by MCOs as encounter claims and therefore would not be present.  Before using the crosswalks, the "ReadMe" section must first be read carefully.  The crosswalks are to be treated as tools for improving MCO encounter submissions.  If there is a discrepancy between these crosswalks versus the MMIS,  the MMIS is correct. 

The crosswalks were designed to be incorporated as validation tables into automated claim systems and/or to be supported by a user friendly query interface that allows for filtering and searching of different field combinations.  Given the number of records involved, the crosswalks were not designed to be stand-alone documents.