MedicaidAdministrativeHigh impact
HealthChoice Illinois (HCI) Managed Care Claim Submission Member Edits
Illinois Medicaid - HFS·IL·Claims & Billing
Effective date
Apr 23, 2026
We identified it
Jun 16, 2026
Summary
Illinois is launching new Advanced Communication Engine (ACE) member edits for HealthChoice Illinois Medicaid managed care claims starting April 23, 2026. Claims will be automatically rejected before reaching MCOs if they contain incorrect Medicaid RIN, date of birth, or eligibility dates, requiring providers to verify member information in MEDI before submitting claims.
Action Required
Before April 23, 2026: Billing team must update workflow to verify all Medicaid managed care members' RIN, date of birth, and eligibility dates in MEDI system before claim submission. Train staff to check MEDI for all HCI MCO claims (Meridian starting 4/23, Aetna 5/7, BCBS 5/21, CountyCare 6/4, Molina 6/18). Update clearinghouse processes to identify and resubmit claims rejected with new STC error codes. Claims with incorrect member information will be automatically rejected before reaching MCOs.