MedicaidAdministrativeHigh impact
Health Insurance Portability and Accountability Act (HIPAA) Claim Formats
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 16, 2003
We identified it
Jun 21, 2026
Summary
Illinois Medicaid providers must transition to new HIPAA-compliant electronic claim formats. Different provider types will use specific X-12 837 standards (Institutional or Professional Version 4010) for electronic claims, while paper claims continue using current forms.
Action Required
By October 16, 2003: Billing team must implement X-12 837 electronic claim formats for Illinois Medicaid - hospitals/hospices/home health use 837 Institutional Version 4010, all other providers use 837 Professional Version 4010. Contact software vendors to ensure compliance testing by April 16, 2003. Pharmacies must use NCPDP Version 5.1. Paper claims can continue using current forms.