The following information is designed to assist a ROCS user in how to identify and resolve rejected billing. All ROCS users must download the "Result" Files at the end of the week for which your ROCS billing was processed. Remember ROCS billing is processed once a week in a "batch" process. All ROCS files submitted by Monday at 5:00pm Central Time will be processed in that same week. The Monday 5:00pm cut-off includes Monday holidays - No Exceptions. ROCS Billing submitted after 5:00pm on any given Monday will be held and "batched" with the following week's processing. The ROCS user's Result Files will be ready for upload on the Friday of the week the billing is processed.
After you have downloaded result files and updated your ROCS records, you can determine the status of the records as noted below for the different record types.
For FFS Bill records look for DHSBILL_MMDDYYYY@HHMM.RSLT
For client records look for DHSCASE_MMDDYYYY@HHMM.RSLT
It is always best to resolve all rejected records as soon as you can. Rejected records always have a Reject Code attached to the record. The list of Reject Codes and how to fix the errors can be found at the following links:
Fee For Service Bill Rejection Codes are at: https://www.dhs.state.il.us/page.aspx?item=42614
Client Rejection Codes are located at: https://www.dhs.state.il.us/page.aspx?item=60887
Provide Rejection codes are located at: https://www.dhs.state.il.us/page.aspx?item=86909
Providers are expected to look up and follow up on billing errors by taking appropriate action to correct the error before resubmitting a record or contact the DD Division or ROCS Help Desk.
Trying to resolve rejected records a year later will result in you or your agency to not get paid for services provided. Fee for Service bills must be submitted, processed and paid within one year of the date of the service. If the record is for a bill and/or service provided in the previous fiscal year, the bill must be processed before the fiscal year Lapse Period cut-off date. Records submitted for the previous fiscal year after the lapse period cut-off date may possibly be sent to the Illinois Court of Claims. Court of Claims billing submitted to the DD Division is denied if date(s) of service are more than 180 days prior to the date the claim is filed with the Court of Claim
For Fee for Service Bill Records
Go to ROCS Services/Bills; Fee for Services; Bill List
When the Bill List screen comes up input the information in the upper section for the application to search for just the set of records you need.
At the bottom of the Client List screen, click on the Process button.This will bring a list if the bills per your search criteria.
Use the Status box at the upper right of the screen to look at the different status types
You can select Rejected to pull up just your rejected bills. Once you have a list of the records, the rejection code on the right will tell you what the problem is. Use the REJECTION LIST button on the lower right to get a list of the rejection codes and their descriptions.
A list of the first few reject codes will show. Use the Next button to move to the next group and Previous button to go back.
The following web site for Fee For Service Bill Rejection Codes provides a list with possible solutions to resolving the rejection:
https://www.dhs.state.il.us/page.aspx?item=42614
For Client Records
Go to ROCS; Client Data; Client List
At the bottom of the Client List screen, click on the Process button.
This will bring up the whole list of all your clients
Use the Status box at the upper right of the screen to look at the different status types.
For Rejected - select the Rejected option and click on Process at the bottom of the screen. This will bring up a list of all the rejected bills you have. You can narrow the list down by adding information to the upper left section of the screen based on if you are looking for a particular client or not.
Once you have a list of your rejected client records, the rejection code on the right will tell you what the problem is. Use the REJECTION LIST button on the lower right to get a list of the rejection codes and their descriptions.
A list of reject codes will open.
Most client registration records will reject because of the diagnosis codes (error code 654). It is best to use only one valid ICD-10 diagnosis code.
You can also find descriptions of the various Client Rejection codes on the following web site: https://www.dhs.state.il.us/page.aspx?item=60887
For Provider Records:
Go to ROCS; Provider Data; Provider List. From there it is pretty much the same as the others.
The web site for Provide Rejection codes is https://www.dhs.state.il.us/page.aspx?item=86909
