Illinois Medicaid 837P Companion Guide
To look up Illinois Medicaid 837P electronic standards for submission, refer to the Illinois Medicaid 837 Professional Companion Guide here. This guide provides detailed specifications and requirements for submitting professional healthcare claims electronically.
Secondary Claim Submission
This payer has a proprietary requirement for identifying the primary payer, which requires the payer ID value entered in Block 9d to be a specific combination of the payer’s TPL Status Codes and its unique payer ID list.
In this example, the value “01189” is made up of two parts that each convey specific information.
- The first two digits, “01”, represent the claim’s adjudication status. A value of 01 indicates that the claim was TPL adjudicated, meaning total payment information is included.
- The remaining digits, “189”, identify the payer associated with the adjudication. In this case, 189 corresponds to United Healthcare.
- When combined, 01189 indicates that the claim was TPL adjudicated with total payment shown, and that United Healthcare is the payer involved.
- Please see the following reference documents for additional details:
• TPL Status Codes: https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/tpl-status-codes.pdf
• TPL Payer ID Codes: https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/tpl-codes-082416.pdf