Traditional MedicareAdministrativeHigh impact
The Medical Electronic Data Interchange (MEDI) System – Identifying Dual Eligible Beneficiaries Enrolled in HealthChoice Illinois Managed Long Term Services and Supports (MLTSS)
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
Beginning July 1, 2019, HealthChoice Illinois MLTSS program expanded statewide, changing billing procedures for dual eligible beneficiaries. Providers must now identify these patients in MEDI by exclusion code '6' and follow specific billing hierarchies: Medicare first, then either HealthChoice Illinois MLTSS health plan or Medicaid FFS depending on the service type.
Action Required
By July 1, 2019: Billing team must update workflows to identify dual eligible beneficiaries with HealthChoice Illinois MLTSS coverage using MEDI exclusion code '6'. Train staff on new billing hierarchy: bill Medicare first for all Medicare-covered services, bill HealthChoice Illinois MLTSS health plan for LTC/HCBS waiver services/non-Medicare behavioral health/non-emergency transportation, and bill Medicaid FFS for all other non-Medicare covered services. Update billing system rules to route claims appropriately based on service type.