Medicare AdvantageAdministrativeMedium impact
Payment of Cost Sharing for Medicare Advantage Plan (MAP) Members Effective July 1, 2015
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2015
We identified it
Jun 20, 2026
Summary
Effective July 1, 2015, providers can now bill Illinois Medicaid for Medicare co-insurance and deductibles for patients enrolled in both Medicare Advantage Plans and Medicaid, reversing the previous policy that required seeking cost sharing from the Medicare Advantage Plan. Claims must be submitted within 24 months using paper forms with specific TPL codes 909 or 910.
Action Required
Immediately: Update billing workflows to submit Medicare Advantage crossover claims to Illinois Medicaid for dual-eligible patients. Use TPL codes 909 or 910 with appropriate two-digit TPL Status Code. Submit paper HFS 3797/837P forms for non-institutional providers and UB04/837I for institutional providers within 24-month filing limit. Review Medicare Explanation of Benefits to identify co-insurance and deductibles before billing Medicaid.