MedicaidAdministrativeHigh impact
Clarification on MCO Hospital Encounter Claim Submittal
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Dec 17, 2014
We identified it
Jun 20, 2026
Summary
Illinois Department of Healthcare and Family Services clarified that MCOs must submit hospital outpatient encounters using HFS 837I forms when they include APL procedure codes, emergency room revenue codes, or observation revenue codes. All other encounters must use HFS 837P forms or the MMIS system will reject them.
Action Required
Immediately: Billing team must verify that all hospital outpatient encounters submitted to Illinois Medicaid MCOs use the correct form type - HFS 837I for encounters with APL procedure codes, emergency room revenue codes, or observation revenue codes, and HFS 837P for all other encounters. Update billing system rules to ensure proper form selection as MMIS will reject incorrectly formatted encounters.