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Paper Claims Rejecting Incorrectly

HFS System Issue: 

Paper claims are rejecting incorrectly for N01, Invalid First Diagnosis code, N02, Invalid Second Diagnosis Code, for dates of service prior to 10-01-15. 

Paper claims are rejecting incorrectly N05, First DX not From ICD-CM for dates of service after 10-01-15.

Problem:

Valid ICD-9-CM codes are required on claims for dates of service prior to 10-01-15.  Valid ICD-10-CM codes are required on claims for dates of service on or after 10-01-15.  Paper claims with valid diagnosis codes for the Date of Service are rejecting inappropriately with HFS Error Code N01, N02, and/or N05.

Providers Impacted:

Non-Institutional providers billing on paper claims forms.

Procedure Codes Impacted:

All

Problem Begin Date:

September 2015

Problem Fix Date:

July 18, 2016

Resolution for Impacted Claims:

The diagnosis system issue has been resolved.  Claims must be rebilled.  For claims past the 180 day timely filing deadline, providers must re-bill the Department on paper and request a time override using the HFS 1624, Override Request Form.  Instructions for the paper override process are explained in detail on the Department’s Non-Institutional Providers Resources webpage.  Providers will have 180 days from the fix date to qualify for an override. 

 

Claims Processing System Issues

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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director