MedicaidAdministrativeHigh impact
Third Party Liability
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Starting July 1, 2012, Illinois Medicaid will reject pharmacy claims for participants with third party coverage unless the pharmacy first bills the primary payer and reports the payment amount in field 431 DV. Claims without proper third party liability (TPL) information will be rejected with error code 41.
Action Required
By July 1, 2012: Pharmacy billing teams must update workflows to always verify and collect all insurance cards from Medicaid participants, bill primary payers first before submitting to Illinois Medicaid, and ensure field 431 DV Other Payer Amount Paid contains accurate payment amounts greater than $0. Update billing system to handle OCC codes 2, 3, and 4 properly. Train staff to call prior authorization hotline at 1-800-252-8942 when TPL disputes arise. Failure to follow TPL requirements will result in claim rejections with error code 41.