Illinois Association of
Medicaid Health Plans

The Illinois Department of Healthcare and Family Services (HFS) requires Managed Care Organizations (MCO) to meet very specific claim data submission standards requiring particular and exact data elements on claims submitted from providers. To facilitate the appropriate application of these rules, Managed Care Organizations are collectively relaying the following information in these provider memorandums and presentations in an effort to reiterate and provide transparency on guidelines in relation to encounter requirements. IAMHP would like to iterate that the information contained within these documents are general requirements and encourages providers to connect directly with the MCOs to whom they are billing in order to gather health plan specific billing requirements.

Provider Memos on Claim Requirements for Encounters

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