MEDI Frequently Asked Questions

How do I obtain a State of Illinois Digital Identity Certicate?

Review the Obtaining a Digital Identity Certificate topic for instructions.

Why do I need a Digital Identity Certificate from the State of Illinois? Why can't I use my own certificate?

The State of Illinois is the certificate authority for all State of Illinois Internet access. Applications available over the Internet that are provided by the Department of Public Aid will only accept certificates from the State of Illinois.

How many digital identities do I need to have?

You only need one digital identity from the State of Illinois. Your digital identity is yours, and you can use it for access to other state agency applications.

How do I protect my digital identity from access by other people?

The digital identity certificate you have is installed in the browser when you access any State of Illinois systems by entering your digital identity's user id and password. Once you Logout successfully or close the browser, the certificate is removed from your computer. Do not share your user id and password with others. If you feel you need to protect your digital identity, you can change the password. Review the Changing Your Digital Identity Password topic for instructions.

If I am planning on registering as a provider and I am not the provider, do I need the provider's driver's license to register for the digital identity?

No. You can register for your digital identity with your own driver's license or identification card and then register as a provider in MEDI. MEDI understands that most of the time, a provider administrator will be registering and managing the provider's account.

If I do not live in Illinois, how do I get a digital identity?

If you do not have an Illinois driver's license or identification card, you can still register for your digital identity online. There are applications available online or out-of-state digital identities that can be printed and mailed in. Review the Obtaining a Digital Identity Certificate for more help.

Once I have obtained a username (digital ID) and password, what is the next step to be able to bill?

You must register each provider for whom you will be submitting claims by going to the “Registration Menu” and selecting “Medicaid Provider”.  You must enter all the information exactly as it appears on your provider information sheet.

Is Medicaid-IL able to accept the ANSI837 4010A1?

Yes, Illinois accepts only 4010A1 format, except for the 824, which is accepted in 4050 format. For a complete list of transactions accepted by Illinois, review the Current HIPAA Transaction Set. However, not all transactions may be implemented yet. Check the IEC System Home Page for more information on which transactions are currently available

Can claims be reviewed with the confirmation/tracking numbers received when uploading attachments or submitting claims?

HFS billing consultants cannot assist with MEDI confirmation/tracking numbers received when uploading attachments or submitting claims, nor look up a claim using a confirmation number.  Billing consultants can only see a claim after it’s been successfully accepted into the claims processing/adjudication system.  For issues submitting a claim into the claims processing system, please contact the MEDI Help Desk

What are your requirements for declaring a submitter production ready?

Illinois Department of Healthcare & Family Services (HFS) has no certification requirements for submitting files for production processing and no test environment to test your transactions. When you are satisfied your files are HIPAA-compliant, you may submit for production. Be sure to put 'P' in the ISA15 to submit for production.

What are your test requirements (e.g. minimum number of claims, service types, etc.)?

Illinois Department of Healthcare & Family Services has no certification requirements for submitting files for production processing.

Through what types of edits will you be processing our test file? Will you just be testing for construction or will you also make edits available that impact adjudication?

Illinois Department of Healthcare & Family Services has no test environment. When you submit a file, HFS will apply Level I - Level IV syntax checking, which will result in a corresponding 997 or 824 response. ST-SE segments can also be rejected if the submitter is not authorized by the provider; and an 824 will be generated. Adjudication edits will be applied through the normal adjudication process, resulting in an 835 response.

How do I upload attachments?

Refer to the November 24, 2021 provider notice. 

Description of test environment?

Currently, HFS has no test environment to test your transactions. When you are satisfied your files are HIPAA-compliant, you may submit for production. Be sure to put 'P' in the ISA15 to submit for production.

How do I know what Claim Frequency Code to use?

See below and/or refer to the Chapter 300 Companion Guide for Professional 837P transactions:                      

·Claim Frequency 1 - Should always be used unless voiding or replacing a claim already approved for payment (paid or pending payment).  Claim frequency ‘1’ should be used if rebilling a previously rejected claim that has been corrected.

·Claim Frequency 7 – Should only be used when you are replacing a previously paid claim or a claim that is pending to pay.  This is a single transaction (void + rebill) that requires the corrected claim to have some of the same data elements as the original paid claim (see Chapter 300 for required matching data elements). 

·Claim Frequency 8 – should only be used to void a previously paid claim.

Does the test system have a dial-up number, or does it require a username or password?

You will use our Web site and your login information from your registration for the digital certificate (after registration process is completed) to access MEDI. From there, you can access the IEC System, if you have authorization. Currently, HFS has no test environment to test your transactions. When you are satisfied your files are HIPAA-compliant, you may submit for production. Be sure to put 'P' in the ISA15 to submit for production.

How do I perform a system-to-system submission, and what protocol should I use?

HFS does not provide system-to-system or server-to-server submission. However, it may be developed at a later date.

You will be able to submit batch files for HIPAA-compliant transactions directly to HFS over the Internet with the new IEC System. To submit files, access the Internet Electronic Claims (IEC) System and click on the File Upload link. We only accept .TXT and .DAT filetypes.

Do we need to inform anyone once we make a submission?

No. The submission will be acknowledged by either or both a 997 and 824. If you do not get any kind of acknowledgment, you should contact the Help Desk.

What is the turnaround time for results once a submission is made? What type of results are made available?

You should receive one or more 997 acknowledgments within a few minutes of submitting a batch file. These acknowledgments indicate whether there are any problems with the enveloping or syntax of the submission.

You may also receive an 824 if there are transactions within the file that did not pass our authorization checking process.

Adjudication of claim submissions will fall under normal MMIS processing goals. Batch submissions for other HIPAA formats have a 24-hour response time. (overnight).

Responses to batch submissions will be provided as batch files in HIPAA-compliant format. These files can be downloaded from the IEC System to the user's computer.

There are DDE functions available for the 270 Eligibility Inquiry and 276 Claim Status Inquiry that provide an immediate response for single inquiries.

How do I know what Third Party Liability (TPL) status code to use?

A listing of TPL status codes can be found on the Medical Provider Handbooks webpage, however, providers should use the TPL source code found on the Eligibility screen on MEDI. 

Where do I find the 3-digit TPL code?

Refer to the Source code under the TPL Information shown on the Eligibility screen.

Do I have to enter information in any of the fields without asterisks?

Some fields which do not have an asterisk must still be populated in some instances.  For example, some provider types are required to enter an ordering/referring/prescribing (ORP) provider (who must be enrolled with IL Medicaid).  This field does not have an asterisk because it is not required by all provider types.  Please refer to the November 9, 2018 provider notice for ORP requirements

What are the different Invoice forms for?

See below….

·Provider Invoice - Audiology, Chiropractic, Local Education Agencies, Optometry, Podiatry, and Therapy providers

·Transportation Invoice – Transportation providers

·Medical Equipment /Supplies Invoice – Durable Medical Equipment (DME) providers

·Laboratory/Portable X-Ray Invoice – Labs/Portable X-Ray providers

·Health Insurance Invoice – Physicians, Independent Diagnostic Testing Facility, Federally Qualified Health Centers, Encounter Clinics, Rural Health Clinics, School Based Clinics, Independent Laboratories, Optometrists, Healthy Kids Clinics, County Health Departments, and Certified Hospital Organized Satellite Clinics and Imaging Centers

·Community Mental Health Centers – Community Mental Health Centers and Behavioral Health Clinics.  NOTE:  These providers must NOT use a Medicare Crossover Invoice, even when there is a Medicare allowed/paid amount.  CMHCs and BHCs must always use this invoice, reporting Medicare information using TPL resource code 999.

·Medicare Crossover Invoice – Used when there is a Medicare or Medicare Advantage Plan allowed amount.  Do not use when Medicare denies a claim.  When Medicare denies a claim, use the invoice applicable to the provider type as indicated above with no TPL code and attach a HFS 1624 Override Request Form and the Medicare denial Explanation of Benefits (EOB).  The HFS 1624 Override Request Form and Medicare EOB must be uploaded and attached to the claim via the electronic attachment portal.  Please refer to the November 24, 2021 provider notice for electronic attachment instructions.

What do the claim status category codes mean when checking claim status?

See below…..

A = Acknowledgement

·A1 - Acknowledgement/Receipt.  Claim has been received.  This does not mean the claim has been accepted for adjudication.

·A2 - Acknowledgement/Acceptance into adjudication system.

·A3 - Acknowledgement/Returned as unable to process.  The claim file has been rejected and has not entered the adjudication system.

·A4 - Acknowledgement/Not Found.  The claim cannot be found in the adjudication system.

P = Pending

·P0 - Pending: Adjudication/Details – This is a generic message about a pended claim.  A pended claim is one for which no remittance advice has been issued, or only part of the claim has been paid.

·P1 - Pending/in Process.  The claim is in the adjudication system.

·P2 - Pending/In Review.  The claim is suspended pending review.  These claims may take additional time to process or be assigned error codes.

F = Finalized 

·F1 - Finalized/ Payment.  The claim has been paid.

·F2 - Finalized/Denial.  The claim has denied.  You will not be able to see the IL Medicaid proprietary error codes, only the HIPPA compliant codes. You must wait for your paper Remittance Advice to see the Medicaid proprietary error codes.

Claim Not Found

·D0 – The claim cannot be found.

o   The claim submission date was more than 90 days ago.

o   HFS did not receive the claim.

What should I use as the Attachment Control Number?

Providers should create their own unique attachment control number for each claim.   The suggested (but not required) ACN format is 21 digits: 9-digit Recipient Identification Number, 8-digit Date of Service and 4-digit sequence number (999999999010120220001).  The attachment control number you assign to your attachment should be the same attachment control number you enter on your claim submission.  The attachment should always be uploaded before sending the claim.  For best results, submit the attachment followed by the claim on the same day before 7pm CST.  

What do the denial codes found on MEDI mean?

The denial codes on MEDI are HIPAA-compliant CARCs/RARCs and can be found with an internet search for HIPAA Compliant Denial Codes.  HFS’ proprietary error codes and descriptions are found on the paper remits and error code listing.

Why would my claim reject R02 – Recipient Name Does Not Match Recipient Number?

See below

·The recipient’s name must be entered exactly as it appears on the eligibility screen in MEDI.  Please be sure to use the name in the Recipient Name field, not the Case Name field.

·If a recipient has a middle name or middle initial, it must be entered in the first name field directly after the first name.  If not, the claim will reject R02. 

·If a recipient has two last names, they should both be entered in the last name field

Where do I enter the co-payment amount?

Our system does not recognize co-payments.  You must enter the co-pay amount in the co-insurance field.  If there is both co-insurance and co-pay, you must add the amounts together and enter the total in the co-insurance field.  There must always be information in at least one of the co-insurance or deductible fields.  

When do I use the Medicare Crossover Invoice?

See below

·If Medicare or a Medicare Advantage Plan makes a payment or applies the entire amount to deductible, you must bill on the Medicare crossover invoice with a TPL code 910 and choose the correct TPL status code.

o   Use status code 01 if Medicare made a payment or status code 10 if Medicare applied the entire amount to deductible. 

o   If Medicare made a partial payment and applied some to deductible, use status code 01.  You must report both the payment amount and the deductible amounts on the claim.

· If Medicare denied the claim, you must bill on the invoice designated for your provider type.

o   You will not report the Medicare TPL information on the claim.

o   You will need to upload a Medicare override request and your Medicare denial EOB and attach it to your claim.  Refer to the November 24, 2021 provider notice for electronic attachment instructions.

What Invoice do I use to submit claims for recipients with a Medicare Advantage Plan (MAP)?

The Medicare Crossover Invoice.

What is the TPL code for Medicare or Medicare Advantage Plans (MAP)?

The TPL code for both traditional Medicare and Medicare Advantage Plans is 910. 

Please Note:  the TPL code for Medicare is only used when there is a Medicare allowed amount and Medicaid is being billed secondary on a Medicare Crossover invoice.

When Medicare denies a claim, the claim should be submitted with no TPL code, using the invoice applicable to the provider type, with the HFS 1624 Override Request Form and Medicare denial Explanation of Benefits (EOB) as attachments.  The HFS 1624 Override Request Form and Medicare EOB must be uploaded and attached to the claim via the electronic attachment portal.

Exception:  Community Mental Health Centers and Behavioral Health Clinics must use TPL resource code 999 to report Medicare primary information when there is a Medicare allowed amount, as well as the Community Mental Health Centers claim invoice.  

How do I register my providers, by medical group or individually?

Providers must be registered individually. If you represent a medical group, clearinghouse or billing service with access to the Provider Information Sheet, the Group Registration for Provider Groups topic provides suggesstions on how to register.

How many providers can I represent?

You can represent as many providers as necessary. If you want to register as the provider administrator for each provider, you must have the appropriate Provider Information Sheet for each provider you want to register. You could also register as an employee of multiple providers. In this case, you would need the Employee Registration Key from the provider administrator(s) for each registered provider. For instructions, we have provided a list of Registration Tutorials to assist you through the registration process.

Is registration a manual process if the business is out-of-state?

No, once you obtain your digital certificate, you can register online through the MEDI System. Registration is required before you will be able to access any applications. Review the Registration Overview for more information.

How does "Other Business" enrollment and delegation to our employees work?

Other businesses (e.g. provider groups, billing services, clearinghouses, software vendors, etc.) may register in the MEDI System to work on behalf of a Medicaid provider. Then, the person (e.g. administrator) that registered the business can request authorization from the provider. Once authorization is received, it can be delegated to the registered employees. Read the Authorization Overview for more detailed information on both business authorization and delegation to employees.

When can we begin and who will be our enrollment contact for assistance at HFS?

You can begin now by obtaining your digital certificate and registering in the MEDI System. There are Help numbers available to call if you need assistance.

I currently have business relationships or agreements with IL Medicaid providers, at numerous practices and institutions, and assist them in filing their transactions electronically. In order to perform this service to them through your MEDI System, will each provider and institution have to grant me this authority within your new IEC System?

Yes. Each provider, by unique provider identification number, will have to authorize the specific MEDI transactions that your business will be allowed to access on their behalf. This process is required to affirm business relationships and prevent unauthorized access to MEDI. Review the Authorization Overview for more information about how to receive authorization.

What is the Claim Status Tracking number?

The claim status tracking number is a number you assign, so any number can be used in this field.  It can be any number, with no minimum number of digits required. 

How can I check claim status?

Billing consultants do not check claim status.  Claim status check is a bookkeeping function that is the responsibility of the provider.  Claim status may be checked by clicking on the “Claim Status Inquiry” link.