MedicaidAdministrativeHigh impact
C97 Rejections for Clinic Providers
Illinois Medicaid - HFS·IL · Family Medicine, Internal Medicine, General Practice·Provider Notice
Effective date
Jun 30, 2020
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has identified system issues causing C97 rejections for FQHC, RHC, and encounter clinic claims with T1015 codes received after June 30, 2020. Providers must rebill rejected claims or void and rebill partially paid claims using specific billing frequencies, with timely filing limits lifted through April 15, 2021.
Action Required
Before April 15, 2021: Billing team must identify all C97 rejections for T1015 encounter codes since June 30, 2020. For complete rejections (Scenario 1): rebill electronically as original claims using frequency code '1'. For partial payments (Scenario 2): void paid detail lines using frequency code '8', then rebill entire claim using frequency code '1'. Claims splitting is causing T1015 and detail codes to receive separate document control numbers requiring this corrective action.