Traditional MedicareAdministrativeMedium impact
The Medical Electronic Data Interchange (MEDI) System - Dual Eligible Beneficiaries Enrolled in Medicaid Managed Long Term Services and Supports (MLTSS) and Medicare
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2018
We identified it
Jun 20, 2026
Summary
Beginning January 1, 2018, dual eligible beneficiaries enrolled in Medicaid Managed Long Term Services and Supports (MLTSS) will be identified differently in the MEDI system with Exclusion Code '6' and specific billing instructions. Providers must bill Medicare first for covered services, then bill Medicaid MCO for long-term care and behavioral health services, and Medicaid FFS for other non-Medicare services.
Action Required
Immediately: Billing team must update procedures to identify MLTSS enrollees using new Exclusion Code '6' in MEDI system instead of previous Code '9'. Train staff on three-tier billing hierarchy: 1) Bill Medicare first for all Medicare-covered services, 2) Bill Medicaid MCO for long-term care, HCBS waiver services, non-Medicare behavioral health, and non-emergency transportation, 3) Bill Medicaid FFS for all other non-Medicare services including prescription drugs, dental, and vision services.