Medicaid Illinois IL621 Public Aid 1 Digit Payee Code

Illinois Medicaid Provider Handbook

on October 14, 2008 HFS updated their requirements for the 1 digit payee code, here is the link to the notice. http://hfs.illinois.gov/all/101408npi.html



1 Digit Payee Code

When a provider wants another entity or person to be paid for the services they render, they must send a 1 digit payee code. These instructions do not apply if the rendering provider is the provider being paid for service.

IL Medicaid requires loop 2010AB Pay to Provider be present and must contain the practice information. Currently they require the 1 digit payee code to be in this loop with a 1D qualifier. HFS is requiring providers to register the NPI of the payee to replace the 1 digit payee code by March 2009.

IL Medicaid also requires that the 2010AA Billing Provider identify the Rendering Provider. Including the Taxonomy Code in loop 2000A.

IL Medicaid does not require Loop 2310B Rendering Provider to be sent.

To send claims in this fashion will require Medisoft v11sp3 or above and InterfaceEDI 2.3.0.154 or above.

Medisoft Setup
Provider Information, Specify a Provider Class with the NPI that represents the payee. Specifying a Provider Class that contains an NPI will cause the program to send that NPI in the 2010AB.
Provider Information, put the 1 digit payee code in the Group ID column on the PINs tab for Illinois Medicaid with a 1D under the qualifier column.
Provider Information, put the Medicaid PIN in the PIN column on the PINs tab for Illinois Medicaid.
EDI Receiver Group Practice check box must not be checked.
  All other EDI Receivers will need to be reviewed to verify the Group Practice check box. Make sure all other receivers have the appropriate setting or those claims may be rejected.
It is recommended that Illinois Medicaid be put on a separate receiver.

InterfaceEDI Setup
Settings, Claim Options
  Send Practice Information in 2010AB Pay to Provider Loop, must be checked (available in version 2.3.0.154 or above)
  Use EDI Receiver Group Practice to determine Group Practice, must be checked.

Optionally a practice could set up the EDI Receivers to send the Medicaid claims separate from their other claims.
See the InterfaceEDI 2.3 Manual, under EDI Receiver Setup about placing SINGLE in Extra 3.