Traditional MedicareAdministrativeHigh 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 MLTSS will be integrated into HealthChoice Illinois and identified in MEDI with Exclusion Code '6' and special billing instructions. Providers must bill Medicare first for covered services, then the Medicaid MCO for long-term care and specific services, and Medicaid FFS for crossover claims and other non-Medicare services.
Action Required
By January 1, 2018: Billing team must update MEDI system procedures to identify dual eligible MLTSS beneficiaries using Exclusion Code '6' instead of '9'. Train staff on new billing hierarchy: Medicare first for covered services, Medicaid MCO for LTC/HCBS waiver services/non-Medicare behavioral health/non-emergency transportation, and Medicaid FFS for Medicare crossovers and other non-Medicare services. Update billing system workflows to route claims appropriately based on service type.