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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/21/2024

 

To:
 Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers
​Date: ​May 21, 2024
​Re:
 New Hospital Error Messages for Hospital Inpatient Claims Spanning More than One Year

This notice informs hospitals of new error messages related to inpatient claims when the service dates span more than one year. These error messages apply only to fee-for-service (FFS) claims. These FFS claims require a special payment process.

On the paper Remittance Advice, the Department of Healthcare and Family Services (HFS) will identify these claims with the following new proprietary error messages. The 835 Electronic Remittance Advice (ERA) will identify the cross-walked Claim Adjustment Reason Code (CARC), Remittance Advice Remarks Code (RARC), or Status Code, as applicable below:

HFS Proprietary Error Code: N93 - HFS Will Pay >1 Yr Span By C13 - Do Not Rebill.  This message lets the hospital know that the claim billed spanning more than one year will be paid by a special voucher known as a C-13.

835 ERA:

       ·Status Code 263 - Length of Time for Services Rendered. Do Not Rebill.

 

HFS Proprietary Error Code: N94 - HFS Has Paid >1 Yr Span By C13 - Do Not Rebill. This message lets the hospital know that the claim spanning more than one year has been paid by C-13 voucher.

835 ERA:

       ·CARC B13 - Previously paid. Payment for this claim/service may have been provided in a previous payment.
       ·RARC M59 - Missing/incomplete/invalid 'to' date(s) of service.

 

HFS Proprietary Error Code: N95 - TPL Paid More Than IL Medicaid Allows

835 ERA:

       ·Status Code 183 - Amount entity has paid. Usage: This code requires use of an Entity Code. 
       ·Entity TQ - Third Party Reviewing Organization (TPO).
       ·CARC 92 - Claim Paid in full.
       ·RARC N891 - The maximum allowable payment for this service/procedure was paid by the primary insurance. No further payment due.

Questions regarding this notice may be directed to a hospital billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

 

Kelly Cunningham, Administrator
Division of Medical Programs