New Edit: Medicaid Waiver Payment for Name/RIN Mismatch

Purpose

To inform the field concerning a payment edit that impacts billings for individuals authorized for services in the Division of Developmental Disabilities (DDD) Adult Waiver, the DDD Children's Residential Waiver, or the DDD Children's Support Waiver. The payment edits have been enhanced for accurate case information to ensure successful claiming of services for federal matching funds.

The name and Recipient Identification Number (RIN) on ROCS must match the name and RIN on the Medicaid record from the local office for the claim to go through. The new payment edit will reject bills that have names and RINS that do not match the Medicaid record. We are doing everything possible to maximize federal Medicaid revenues to help address the State's fiscal situation, and this is part of those efforts.

Process and Procedure

The new payment edit will be implemented beginning with bills processed on or after March 1, 2011.  Bills that reject due to the implementation of the new payment edit will have one of the following error codes:

•  61 - Name Mismatch with DPA Medicaid
•  96 - DPA RIN Lacking or Incorrect in ROCS

Please ensure that the name and RIN in your ROCS case information match the name and RIN on the Medicaid record to prevent billing rejections for the above errors.

Note:  If the Medicaid name is incorrect according to your records, it may only be corrected at the Medicaid local office (Family Community Resource Center) at the request of the individual, family or representative. The Division (DDD) cannot correct the name on the Medicaid record. Please take steps to ensure needed corrections are made.

If you have any questions regarding the payment edit, please contact:

Pat Moreno, Medicaid Waiver Unit
Email:  pat.moreno@illinois.gov
Phone:  (217) 782-4139.