Provider Notice Issued 10/05/2018

Date:  October 5, 2018     
To:     All Medical Assistance Program Providers
Re:     Improper Submission of the CMS 1500, Health Insurance Claim Form
This notice is a reminder that if providers choose to bill paper claim forms, only HFS proprietary paper claim forms are to be submitted for billing Medicaid non-institutional services or supplies. This applies to claims for participants who are covered under fee-for-service Medicaid and are not enrolled in a HealthChoice Illinois managed care plan. Providers should refer to the applicable plan for managed care billing guidelines.
The Department cannot process the CMS 1500 claim form. Due to the volume of CMS 1500 forms that the Department receives, staff is unable to return them to providers. Providers will not be able to determine a claim status for a service submitted on a CMS 1500.
HFS strongly encourages providers to bill the Department electronically using the Medical Electronic Data Interchange Internet Electronic Claims (MEDI IEC) System. However, if providers must submit paper forms, the attachment to this notice identifies the appropriate paper forms to be used by non-institutional providers when billing for services rendered and/or equipment supplied to HFS participants. Paper claim forms may be ordered from the Department’s website.
More specific billing guidance is contained in Provider Handbooks that are located on the Department’s website. The appendices contain billing and mailing instructions for the specific HFS proprietary paper claim form to be used by the provider.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Teresa T. Hursey
Medicaid Director

Form Number
Form Title
Provider Type or Service
HFS 215
Drug Invoice
HFS 1443
Provider Invoice
Community Mental Health Centers billing SASS services  
Local Education Agencies  
Optical Supplies
Physical/Occupational/Speech Therapies
HFS 2209
Transportation Invoice
HFS 2210
Medical Equipment/Supplies Invoice
Audiology (hearing aids and supplies)
Durable Medical Equipment and Supplies
HFS 2211
Laboratory/Portable X-ray Invoice
Lab and X-ray services
HFS 2212
Health Agency Invoice
Home Health services
HFS 2360
Health Insurance Claim Form
Advanced Practice Nurses
Dentists (for covered medical services not billable under the Dental Program)
Federally Qualified Health Centers/Rural Health Centers/Encounter Rate Clinics
Imaging Centers
Independent Diagnostic Testing Facilities
Licensed Clinical Social Workers
Licensed Clinical Psychologists
Local Health Departments
Outpatient Hospitals services (designated in the Handbook for Practitioner Services)
School- Based Clinics
HFS 3797
Medicare Crossover Invoice
All non-institutional services after Medicare adjudication



 Need Assistance?