MedicaidAdministrativeHigh impact
Care Coordination Health Plan Identification and Billing Procedures Depending on Health Plan Enrollment
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Mar 9, 2015
We identified it
Jun 20, 2026
Summary
Illinois Medicaid providers must use different billing procedures based on the type of managed care entity their patients are enrolled in. For ACE/CCE enrollees, bill HFS directly; for MCO/MCCN enrollees, bill the health plan directly.
Action Required
Immediately: Billing team must verify each Medicaid patient's health plan enrollment using REV, MEDI, or AVRS (1-800-842-1461) before submitting claims. For ACE/CCE patients, continue billing HFS directly using RIN. For MCO/MCCN patients, bill the health plan directly. Update billing workflows to check enrollment status for every Medicaid claim to avoid denials.