Medicaid Claim Filing Update: System Edits Effective May 16, 2015

Posted May 1, 2015

As a reminder, the Illinois Department of Healthcare and Family Services (HFS) notified all Medicaid providers on Dec. 17, 2014, regarding the proper procedure for submitting outpatient services with procedures from the Ambulatory Procedure Listing (APL).

In accordance with the terms of the agreement between Blue Cross and Blue Shield of Illinois (BCBSIL) and your practice, providers must submit claims in an acceptable manner. Proper claim submission is critical, as system edits may be in place to reject claims that do not include required information.

Effective May 16, 2015, BCBSIL will implement a system edit for Illinois Medicaid electronic institutional and professional claims (837I and 837P transactions) to reject any claim that does not abide by the following:

  • All outpatient APL services must be billed in the institutional claim format.
  • The outpatient claim must contain only one date of service per claim, with the exception of series billable and ER/Observation services.
  • Any date of service that does not have an APL service must be billed in the professional claim format.

For information on additional BCBSIL system edits, refer to the Medicaid Claim Filing Update chart, located in the Claims and Eligibility/Claim Submission section, under the Related Resources.