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 For secondary claim submission to Illinois Medicaid (HFS),  the Primary Payer ID  must be a combination of the 3-digit TPL (Third-Party Liability) code followed by a 2-digit Status Code. For a complete list of TPL codes, see here . To view the corresponding status codes, refer to the official document at HFS TPL Status Codes .

Start: 01/01/1995 | Last Modified: 07/01/2017 91 Entity not eligible/not approved for dates of service. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 92 Entity does not meet dependent or student qualification. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 93 Entity is not selected primary care provider. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 94 Entity not referred by selected primary care provider. Usage: This code requires use of an Entity Code. Start: 01/01/1995 | Last Modified: 07/01/2017 95 Requested additional information not received. Usage: At least one other status code is required to identify the requested information. Start: 01/01/1995 | Last Modified: 11/01/2024 96 No agreement

result in a payment hold in the near future. Start: 03/06/2012 N551 Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program. Start: 03/06/2012 N552 Payment adjusted to reverse a previous withhold/bonus amount. Start: 03/06/2012 N554 Missing/Incomplete/Invalid Family Planning Indicator. Start: 07/01/2012 | Last Modified: 03/14/2014 Notes: (Modified 3/14/2014) N555 Missing medication list. Start: 07/01/2012 N556 Incomplete/invalid medication list. Start: 07/01/2012 N557 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected. Start: 07/01/2012 N558 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received. Start: 07/01/2012 N559 This claim/service

Re-enrollment may be necessary for various reasons, including if the original enrollment failed or was never processed, if we changed our route for the payer, or if the provider office somehow changed the route. Additionally, there are other reasons that might require re-enrollment to re-establish the connection to Claim.MD. Steps to re-enroll: Click on the correct provider in the list. Find the "Completed" link for either Claims, ERA, or Eligibility next to the correct payer.  Click the Re-Enroll button on the bottom left. Click the Enroll button that appears. In this image, it is a Quick Enroll, but it may also include enrollment paperwork or external links to complete.

Provider ID Instructions When Operating Multiple Locations When submitting claims to Alabama Medicaid, it is important to include the Provider ID when the Rendering Provider and/or the Billing Provider   operate from multiple locations. This ensures accurate processing and payment of claims. Alabama Medicaid accepts both the National Provider Identifier (NPI) and Provider ID on claims. Specifically, the Provider ID should be included in the Billing Provider segment (2010BB|REF G2) and the Rendering Provider segment (2310B|REF G2) of the claim submission. Medicaid Provider ID and NPI Crosswalk Per HIPAA 5010 X12 standards, Medicaid is not allowed to receive a Medicaid provider ID on electronic claims, if the provider has an NPI. This payer uses a table of information or "crosswalk" to associate the payer assigned provider IDs to each claim. Verify the information sent in these fields matches the provider ID record in the payers system: Provider NPI

The Payer Specific Bill ID/Submitter ID for Arizona's Medicaer Part A is a unique identifier that ensures accurate claim submission and processing for healthcare providers working with this specific payer, helping to streamline reimbursements and maintain compliance with Arizona's healthcare billing requirements. Payer Specific Bill ID/Submitter ID This payer requires a payer assigned ID number. This value can be sent in block 33b, bill_id Loop 2010AA, REF02, REF01=G2.  This submitter ID value will be acquired during enrollment or by contacting Noridian EDISS.

Important These reports are specifically about claims processed through Claim.MD. If you receive a payment reference with an Electronic Remittance Advice (ERA) for a claim handled by Claim.MD, it provides details about that particular payment. Importantly, Claim.MD reports don't deal with balancing your overall accounts receivable (A/R) . Instead, reports dealing with payments focus on the specific payment information related to individual claims processed through Claim.MD. All the reports listed below are found in the Reporting page which is located in the left navigation menu.  Billed Charges by Payer: Why Run this Report: Monitor revenue distribution: Gain insights into how your revenue is distributed among different payers. Identify high-paying payers: Discover which payers contribute the most to your revenue and focus on building stronger relationships with them. Detect underperforming payers: Identify payers with lower billed charges and explore opportunities to improve reimbursement rates

Basic API Workflow Please review the API Technical Documentation for guidance on configuring the Claim.MD API. Workflow Considerations Consult with someone in your company who handles billing to better understand the normal workflow for submitting claims, receiving ERA and checking patient eligibility. Familiarize yourself with the typical process of receiving both a claim status update from the payer and payment details as part of a payer EOB/Remittance. Understanding this workflow can enhance your integration and utilization of the provided services. The ‘Accept’ HTTP header controls if API results are returned in the XML (application/xml) or JSON (application/JSON) formats. You must determine if your users will have their own Claim.MD accounts with direct access to the portal, or if the software vendor will retain a single Claim.MD account and offer no Provider access. Provider Direct Access - Minimum Requirements If each provider/customer will have

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In medical billing, a corrected claim is a resubmission of a healthcare claim with revised information to rectify errors in the original submission, ensuring accurate details for processing by the insurance payer. Navigate to the View/Edit Claim page by searching for the claim on the Search page. Go to the Type of Bill (TOB) field ( FL04 ) and replace the third digit to "7". Proceed to enter the Document Control Number (DCN)  or Claim Number field (FL64) for the corrected claim. Click the  button at the top of the screen. This will resubmit it as a corrected claim. More Information Medicare does not accept electronic corrected claims. If Medicare has adjudicated a claim, the appeals process would need to be used to request a correction.  

Situational XML / JSON Field mod1, mod2, mod3, mod4 X12 Loop / Segment SV202-3 through SV202-6 (Modifiers) Allowed Values 2 characters Notes Field Name Service Date Description  "Dates of Service," is the date when services were first provided. Paper Claim Block 45 Required / Situational Required XML / JSON Field from_date X12 Loop / Segment Loop 2400 - DTP01 (Value 472 – Service date), DTP02 (Value D8 – Format:, CCYYMMDD or RD8 – Date Range)DTP03 (Date or Dates) Allowed Values Date yyyymmdd Notes Field Name Units (Service Units) Description This captures the quantity of healthcare services provided, such as "5" for inpatient days or "3" for outpatient visits, crucial for precise billing and claims processing. Paper Claim Block 46 Required / Situational Required XML / JSON Field units X12 Loop / Segment Loop 2400 - SV204 (Value DA – Days or UN –Units), SV205 (Service Unit Count) Allowed Values (dropdown UN/DA) and 6 characters for number of units

The Manage Users page in Claim.MD enables administrators to create, delete, and manage user access and permissions. This ensures that only authorized individuals can access sensitive information and perform critical tasks. Access to this page is restricted to administrators only. User Types Administrator: Has full control over user management, settings, and system features. Only administrators can configure SFTP/API setups. Standard: Access can be limited to specific features, but users can view all provider data within their permitted features. Eligibility Only: Restricted to eligibility access for a single provider, with no visibility into eligibility history. Accounting/Invoices: Limited to the View/Pay Invoices page. HIPAA Compliance To comply with HIPAA regulations, each user must have unique login credentials exclusive to Claim.MD. Sharing login information compromises the confidentiality of personal health information and is strictly prohibited. Adding a New User Click the Manage Users button on the left-hand

The Manage Claims page highlights claims requiring attention.  Click on Manage Claims in the left-hand navigation menu. Graphs Recent Uploads Graph The Recent Uploads graph displays claim activity over the past seven days , grouped by status. It helps users quickly assess recent claim submissions and their outcomes. Users can click on each category in the graph to view a filtered list of the associated claims: Rejected claims Transmitted claims Pending Approval Deleted claims Recent Transmits Graph The Recent Transmits graph shows claim transmission activity over the past 30 days . It provides insight into how many times claims were sent electronically to payers, helping users identify submission patterns and potential follow-up needs. Transmitted: The claim was sent electronically to the payer. Note: This status does not confirm the payer received the claim—only that it was submitted. Re-Transmitted: The claim was sent electronically more than once to the

Payer Specific Bill ID/Submitter ID This payer requires a payer assigned ID number. This value can be sent in block 33b, bill_id Loop 2010AA, REF02, REF01=G2.  This submitter ID value will be acquired during enrollment or by contacting Noridian EDISS.

The Payer Specific Bill ID/Submitter ID for Hawaii Blue Cross is a unique identifier that ensures accurate claim submission and processing for healthcare providers working with this specific payer, helping to streamline reimbursements and maintain compliance with Hawaii's healthcare billing requirements. Payer Specific Bill ID/Submitter ID This payer requires a payer assigned ID number. This value can be sent in block 33b, bill_id Loop 2010AA, REF02, REF01=G2.  This submitter ID value will be acquired during enrollment or by contacting Noridian EDISS.  

View/Pay Invoices The View/Pay Invoices page allows organizations to review their invoices, update their recurring payment method, and make one-time payments to Claim.MD. Click on the View/Pay Invoices page in the left-hand navigation panel. Current Account Balance The **Account Balance** pane at the top of the screen displays the current balance due. Invoice History The Invoice History section in the middle of the screen allows users to review past invoices. Click on any blue link (Date, Invoice #, New Charges, etc.) to view a detailed invoice for that billing period. Understanding Invoices Balance Forward: Displays any unpaid balance from previous invoices. Transaction Fees: For plans with per-transaction charges, the number of processed claims and ERAs and their associated fees are displayed. Subscription Fee: Monthly or annual fees are itemized. Tax ID Fees: For applicable plans, additional fees based on Tax IDs are included. View

This section helps verify a patient's insurance coverage, determine covered services, and identify any co-payments or deductibles the patient may owe. Steps to Check Eligibility      Navigate to Eligibility in the left navigation menu.      Select a Provider from the dropdown.      Choose a Payer from the second dropdown.      In the Eligibility Information dropdown, select:                       Benefit Type (selected from the dropdown), or              Procedure Code (entered manually).                    Provide patient details— Policy# or Date of Birth is required.      Click the          Check Eligibility button to generate results.           Important      Most payers do not respond to the Procedure Code and only recognize the Benefit Type. Eligibility Results      Use the Jump to Benefit Category dropdown to navigate directly to specific categories like Pharmacy, Urgent Care, and Physical Therapy.           Web Portal Request Limits      The portal has limits on eligibility checks per second. Exceeding the limit results in: "Error: Too many requests. Try again later." Prevent Unnecessary Eligibility Requests

claims by clicking the Approve Transmit button. d. A pop-up will confirm the number of claims marked for transmission (e.g., "51 claims are marked to transmit"). Click OK to clear the pop-up. Turning Off Transmit Approval Required If your organization wishes to transmit claims automatically without prior approval on the Manage Claims page, an administrative user can achieve this by navigating to the Settings page on the left navigation menu. Once there, they can click on the Account Settings tab and unselect the option for "Transmit Approval". The Account Settings article has more information about this and other settings.  Conclusion: Transmitting documents, such as medical claims, in Claim.MD is essential for seamless healthcare billing and reimbursement. SFTP and API are reliable methods to transfer data from your PMS or billing software to Claim.MD. Remember to monitor the "Pending Approval" notification and ensure that claims are

Question : How do I look at past claims? I submitted claims over 2 weeks ago and can no longer find them on my Manage Claims. Answer : You can go to the Search page and enter the Member ID Number or the Last Name and it will pull up all claims for that specific patient.  For more detail, see this article . 

IMPORTANT! Cancellation of accounts can only be completed by logging into the account and requesting the cancellation online. Cancellations are not accepted via phone or email. To cancel a Claim.MD account, follow these steps:   Log into Claim.MD account. Click Settings Click the Account Settings  tab . IMPORTANT! Only Administrative Users have access to the Account Settings tab.  Scroll down and click C ancel Account. A notification window will display. Click the Cancel Account Button to continue with the cancellation.  A Pop-up box will display to finalize the cancellation. It will prompt you to provide a reason for cancelling the account. Enter a brief summary of the reason in the info box and select Confirm Cancellation . WARNING! Once the cancellation is confirmed, the cancellation will be effective immediately. All account history, including claims, ERA and eligibility will be permanently deleted. This operation cannot be undone.