Is Medicaid-IL able to accept the ANSI837 4010A1?
What are your requirements for declaring a submitter production ready?
What are your test requirements (e.g. minimum number of claims, service types, etc.)?
Description of test environment?
Does the test system have a dial-up number, or does it require a username and password?
How do I perform a system-to-system submission, and what protocol should I use?
Do we need to inform anyone once we make a submission?
Is Medicaid-IL able to accept the ANSI837 4010A1? |
Yes, Illinois accepts only 4010A1 format, except for the 824, which is accepted in 4050 format. For a complete list of transactions accepted by Illinois, review the Current HIPAA Transaction Set. However, not all transactions may be implemented yet. Check the IEC System Home Page for more information on which transactions are currently available.
What are your requirements for declaring a submitter production ready? |
Illinois Department of Healthcare & Family Services (HFS) has no certification requirements for submitting files for production processing and no test environment to test your transactions. When you are satisfied your files are HIPAA-compliant, you may submit for production. Be sure to put 'P' in the ISA15 to submit for production.
What are your test requirements (e.g. minimum number of claims, service types, etc.)? |
Illinois Department of Healthcare & Family Services has no certification requirements for submitting files for production processing.
Through what types of edits will you be processing our test file? Will you just be testing for construction or will you also make edits available that impact adjudication? |
Illinois Department of Healthcare & Family Services has no test environment. When you submit a file, HFS will apply Level I - Level IV syntax checking, which will result in a corresponding 997 or 824 response. ST-SE segments can also be rejected if the submitter is not authorized by the provider; and an 824 will be generated. Adjudication edits will be applied through the normal adjudication process, resulting in an 835 response.
Description of test environment? |
Currently, HFS has no test environment to test your transactions. When you are satisfied your files are HIPAA-compliant, you may submit for production. Be sure to put 'P' in the ISA15 to submit for production.
Does the test system have a dial-up number, or does it require a username and password? |
You will use our Web site and your login information from your registration for the digital certificate (after registration process is completed) to access MEDI. From there, you can access the IEC System, if you have authorization.
Currently, HFS has no test environment to test your transactions. When you are satisfied your files are HIPAA-compliant, you may submit for production. Be sure to put 'P' in the ISA15 to submit for production.
How do I perform a system-to-system submission, and what protocol should I use? |
HFS does not provide system-to-system or server-to-server submission. However, it may be developed at a later date.
You will be able to submit batch files for HIPAA-compliant transactions directly to HFS over the Internet with the new IEC System. To submit files, access the Internet Electronic Claims (IEC) System and click on the File Upload link. We only accept .TXT and .DAT filetypes.
Do we need to inform anyone once we make a submission? |
No. The submission will be acknowledged by either or both a 997 and 824. If you do not get any kind of acknowledgment, you should contact the Help Desk.
What is the turnaround time for results once a submission is made? What type of results are made available? |
You should receive one or more 997 acknowledgments within a few minutes of submitting a batch file. These acknowledgments indicate whether there are any problems with the enveloping or syntax of the submission.
You may also receive an 824 if there are transactions within the file that did not pass our authorization checking process.
Adjudication of claim submissions will fall under normal MMIS processing goals. Batch submissions for other HIPAA formats have a 24-hour response time. (overnight).
Responses to batch submissions will be provided as batch files in HIPAA-compliant format. These files can be downloaded from the IEC System to the user's computer.
There are DDE functions available for the 270 Eligibility Inquiry and 276 Claim Status Inquiry that provide an immediate response for single inquiries.