Billing Requirements Reminders for Substance Use, Prevention and Recovery Providers (SUPRs)
Date: 03/27/26
Meridian will validate all claims received on or after February 26, 2026, based on regulatory rules established by Illinois Healthcare and Family Services (HFS) for SUPR providers.
Providers registered with HFS as provider type 075 must follow required rules noted in the tables below. This information can also be found in the Illinois Association of Medicaid Health Plan’s (IAMHP) Comprehensive Billing Guide under the “Coding Requirements” section in the Substance Use Prevention and Recovery Services (SUPR) chapter. Visit the IAMHP website to learn more and download a copy of the manual.
Professional Claims (837P) Billing Reminders
- As indicated in the SUPR Services chapter, non-Methadone services billed on an 837P must contain the taxonomy code for the SUPR facility in the 2010AA billing loop.
Taxonomy
261QR0405X or 276400000X
- SUPR providers registered with IMPACT for Category of Service 106 – Methadone Clinic must use the following taxonomy code in the 2010AA billing loop.
Taxonomy
261QM2800X
- SUPR providers are advised to either suppress the rendering loop (2310B) for 837P claim submissions or submit the NPI for the SUPR facility site in the rendering loop. DO NOT submit the individual clinician NPI in the 2310B rendering provider loop.
Institutional Claims (837I) Billing Reminders
As indicated in the SUPR Services section, for services billed on an 837I, the 2010AA billing loop of the 837 must contain the taxonomy code for the SUPR facility and be one of the following Bill Types:
Taxonomy | Type of Bill |
|---|---|
32450000X or 325S0500X | 086X or 089X |
- A Value Code of 80 is required on all 837I claims and should be reported as the total days of the accommodation revenue code (944 or 945). Billing examples can be found in the IAMHP Billing Manual.
- If a member is discharged on the same day as admission, the ‘Statement From’ and ‘Statement Through’ date can be the same or equal and the Value 80 submitted on the claim should be equal to 1 with the appropriate line level revenue code and procedure code.
- Field 14- Type of Admission or Visit (2300 Loop CL1 Segment -CL1-01 Admission Type) must be present on the claim and must be equal to 1 5. HFS only accept codes 1 – 5. The CMS value of 9 for ‘Information Not Available’ is not accepted by HFS.
- SUPR services are to be billed with statement from and statement through dates and ONE applicable line level dates of service for services (LX*1).
- Example = when billing H0047 claim should include statement from and through dates and service line detail of when services were received. Example:
- LX*1
- SV2*0945*HC>H0047*20169*UN*26
- DTP*472*RD8*20190401-20190427
Units must be defined as units (UN), not days (DA), at the line level - The month ‘statement from’ date and the month of the ‘statement through’ date must be the same month when billing interim claims. For stays under 30 days (Bill Type XX1), the claim can cross months. For additional guidance refer to Inpatient Hospital Coding Guidance found in the IAMHP Billing Guide regarding Statement and Admission Dates. See the interim claim rules and Value Code 80 rules below.
- Example = when billing H0047 claim should include statement from and through dates and service line detail of when services were received. Example:
- If a member is being dually treated for both alcohol and substance use, the primary admitting diagnosis should be utilized to determine the appropriate revenue code (944 or 945) for the claim.
- POA (Present on Admission) is NOT required for 837I SUPR claims.
- Attending Physician is NOT required on 837I SUPR claims.
Interim Claims
Claims for inpatient services rendered and paid by the per diem reimbursement methodology cannot be split unless the stay exceeds 30 days or unless the patient is transferred to another facility or category of service.
- If billing on an interim basis, claims must be billed monthly with month statement from date and the month statement through date. For additional guidance refer to Inpatient Hospital Interim Claims coding guidance in the IAMHP Billing Manual. The month statement from date and the month of statement through date must be the same month.
- Revenue codes 944 or 945 are considered accommodation codes and must follow the same rules as inpatient hospital interim billing. Billing examples can be found in the SUPR chapter of in the IAMHP Billing Manual.
- Patient status 30 must be billed for interim claims
- Type of Bill = XX2 or Interim- First Claim = (DOS Thru Date minus DOS from Date) + 1
- Type of Bill = XX3 or Interim- Continuing Claim = (DOS Thru Date minus DOS from Date) + 1
- On interim claims, it is allowable to include day of discharge in covered/non-covered day calculations.
Providers who are eligible to bill in an interim fashion should note the following:- Services billed should be in one-month increments
- Example 1: 3/1/19-3/31/19
- Example 2: with an admit date of 2/6/19 → 2/6/19-2/28/19
- Services billed should be in one-month increments
Interim First Claim, Interim Continuing Claims and Interim Final Claims
- 892/ 893 Bill Type- MUST BE BILLED IN MONTHLY INCREMENTS per HFS. Statement From and Statement Through dates cannot cross months when billing on an interim basis.
- The statement from and statement through plus 1 is the value code 80 calculation
Effective February 26, 2025, claims that fail any of the following validation checks will be denied as indicated:
EX Code | Description | Edit Applies to Form Type | Claim Remediation |
|---|---|---|---|
EXmo | EXmo- SUPR BILLING INTERIM AND/OR FINAL BILL FAILURE* | 837I | HFS mandates that interim continuing claims (claim frequency code = 3) are billed for a monthly iteration. Resubmit for the full month with statement from and statement through appropriate dates for the month. Include the appropriate value code 80 and day count for the month-long interim claim. |
HFS mandates that ‘first interim’ (claim frequency code = 2) claims are billed for a monthly iteration. Resubmit the claim with the admit date till the end of the month with the appropriate ‘statement from’ and ‘statement through’ date for the month. Include the appropriate value code 80 and day count for the first interim month claim. | |||
EXGo | DENY: INTERIM FACILITY CLAIMS BILLED WITHOUT DISCHARGE STATUS CODE 30** | 837I | If claim frequency code is equal to ‘2’ (‘first interim’) or ‘3’ (continuing interim’) then the patient discharge status code must be set to ’30’. This code indicates the patient is ‘still a patient’ at the facility. |
EX8d | DENY: DISCHARGE STATUS INVALID FOR TYPE OF BILL*** | 837I | If claim frequency code is equal to ‘1’ (‘admit through discharge’) or ‘4’ (final interim’) then the patient discharge status code cannot be set to ’30’. |
Exbd- | DENY: MISSING VALUE CODE 80 AND/OR 81**** | 837I | HFS requires a count of the line level revenue code 944 or 945 billed submitted as Value Code 80 or 81 on the claim. Resubmit with the appropriate value code 80 or 81. |
EXcH | DENY: ADMISSION TYPE IS MISSING OR INVALID***** | 837I | HFS mandates that Field 14- Type of Admission or Visit- (2300 Loop CL1 Segment -CL1-01 Admission Type) must be present on the claim for SUPR providers and must be equal to 1 - 5. HFS only accept codes 1 – 5. The CMS value of 9 for ‘Information Not Available’ is not accepted by HFS. Correct the data and resubmit. |
EXRG | INAPPROPRIATE TAXONOMY SUBMITTED FOR SERVICES PROVIDED****** | 837P | Validate that the appropriate taxonomy was submitted in the billing loop for the type of bill and service being submitted. |
Support
For questions, please contact Provider Services at 866-606-3700 or reach out to your Provider Engagement contact. For additional billing requirements, consult the IAMHP Billing Guide.
CARC/RARC Codes:
* CARC 16 / RARC MA30
** CARC 16 / RARC N318
*** CARC 16 / RARC N50
**** CARC 16 / RARC M49
***** CARC 16 / RARC MA41
****** CARC 16 / RARC N255