Illinois Medicaid electronic claim exclusion codes

RelayHealth has identified claim rejections for CPID 2488 Illinois Medicaid regarding invalid NPI/Provider information being reported on claims.

The following error messages are being returned from the Intermediary with rejection information:

• ERROR MESSAGE: MEDICAID REQUIRES A 1 DIGIT PAYEE CODE
• ERROR MESSAGE: THE NATIONAL PROVIDER ID (NPI) IS REQUIRED FOR THIS PAYOR - LOOP 2010A
• ERROR MESSAGE: THE NATIONAL PROVIDER ID (NPI) IS REQUIRED FOR THIS PAYOR - LOOP 2010AB
• ERROR MESSAGE: THE NATIONAL PROVIDER ID (NPI) IS REQUIRED FOR THIS PAYOR - LOOP 2310B

To avoid continued claim rejections, there are two options for sending provider information correctly in order for claims to be paid properly at the payor:

Option 1: When Loop 2010AB Pay-to Provider IS NOT sent on a claim:
Loop 2010AA Billing Provider Loop must contain NPI
Loop 2010AA REF01 must be sent and must = 1D
Loop 2010AA REF02 must be sent and must contain the 9, 10 or 12 numeric legacy Medicaid Provider ID followed by a single space delimiter followed by the 1 digit payee code to identify the pay to provider.

Option 2: When Loop 2010AB Pay-to Provider IS sent on a claim:
Loop 2010AA should contain the same information as above
Loop 2010AB Pay-to Provider Loop must contain NPI
Loop 2010AB REF01 must be sent and must = 1D
Loop 2010AB REF02 must be sent and must = 1 digit payee code in position 1
RelayHealth will be adding the following NPI edits on June 13, 2008:

RelayHealth will be adding the following NPI edits on June 13, 2008:
EDIT HU 0019C: INVALID BILLING PROVIDER ID QUAL – IN LOOP 2010AA(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0020C: INVALID PAY-TO PROVIDER ID QUAL – IN LOOP 2010AB, NM108 MUST BE EQUAL TO XX
EDIT HU 0022C: INVALID CLAIM REND PRV ID QUAL – IN LOOP 2310B(PROF), NM108 MUST BE EQUAL TO XX

Action Required: Please ensure you are reviewing your payor reports and make the necessary corrections for sending claims to this payor.

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