Agencies
Services
Provider Notice issued 01/09/2024
| To: | Enrolled Providers of Non-Institutional Services |
| Date: | January 9, 2024 |
| Re: | Fee-for-Service Payment Delay |
The purpose of this notice is to inform participating Non-Institutional Provider Service (NIPS) providers of a fee-for-service billing issue. This notice does not pertain to claim submissions by HealthChoice Illinois managed care organizations (MCOs).
A recent system update resulted in a significant number of NIPS claims received in mid- to late December to set a ‘hold’ edit due to missing or erroneous information. This did not impact all NIPS claims during this period.
Efforts to resolve the issue and allow claims that set the hold edit to be released for payment are underway. This is a Department priority.
Once these claims are released, they will process with Department proprietary error code C93 – Department will reprocess claim. The 835 Electronic Remittance Advice (ERA) Reason and Remark Code (RARC) will be B7 and M143. As the proprietary error code message indicates, providers should not resubmit any claims that reject C93. These claims will be integrated into daily processing until the backlog is eliminated. Reprocessing of these claims is expected to occur over a period of the next several weeks. Should any of the claims reject for timely filing due to this Department processing delay, providers may resubmit with a request for a timely filing override.
The hold edit error slowed payments for NIPS claims received January 2nd through January 5th, 2024. Those claims are being processed this week and normal processing has resumed for NIPS claims received on or after January 8th.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs