UB04/837I Box 45 ‘Service Date’ Field Billing Requirements Change for Specialized Mental Health Rehabilitation Centers

Date: 09/25/25

For all claims received on October 1, 2025, Meridian will validate Box 45, “Service Date” field, on the UB04/837I based on regulatory rules implemented by Illinois Healthcare and Family Services (HFS) in 2025 for Specialized Mental Health Rehabilitation Centers (SMRHFs).

Providers registered with HFS as provider type 038, must follow required service line date rules noted in the table below in bold from the Illinois Association of Medicaid Health Plan’s (IAMHP) Comprehensive Billing Guide section for SMRHFs, item F “Coding Requirements” portion. Visit the IAMHP website to download a copy.

Form Locator Field	Explanation	Completion Needed	Comments
45	Service Date	Required	Ok to bill for the span such as 3/1-3/31/19 if days are consecutive. When there is an LOA, group service dates and rev codes together when consecutive. If the service dates are not consecutive, providers need to split the dates for that revenue code on separate service lines rather than combining the days on one line. Examples: 1A) This is an example of an incorrect billing format: HIABK:F259:::::::N HIABJ:F259 *HIBI:74:RD8:20241012-20241013** HIBE: 80:29BE:81:::2BE:23:::903 HIBG:C1 HCP134129.93 NM1711AKIRAALAN***XX1710470257 PRVATPXC2084P0800X LX1 SV201203300DA11 DTP472RD820241001-20241031 This rev code is for 11 days. The specific date ranger must be billed LX2 SV20183*214DA2214 DTP472RD820241001-20241031 This rev code is for 2 days, and the occurrence span 74 shows the LOA days as 10/12/24-10/13/24, so those days should have been listed here instead of 10/01/24 – 10/31/24 LX3 SV20120*5400DA18 DTP472RD820241001-20241031 This rev code is for 18 days. The specific date ranger must be billed 1B) This is an example of a correct billing format: HIABK:F259:::::::N HIABJ:F259 *HIBI:74:RD8:20241012-20241013** HIBE: 80:29BE:81:::2BE:23:::903 HIBG:C1 HCP134129.93 NM1711AKIRAALAN***XX1710470257 PRVATPXC2084P0800X LX1 SV201203300DA11 DTP472RD820241001-20241011** LX2 SV20183*214DA2214 DTP472RD820241012-20241013** LX3 SV20120*5400DA18 DTP472RD820241014-20241031**

Form Locator Field

Explanation

Completion Needed

Comments

Service Date

Required

Ok to bill for the span such as 3/1-3/31/19 if days are consecutive.

When there is an LOA, group service dates and rev codes together when consecutive.

If the service dates are not consecutive, providers need to split the dates for that revenue code on separate service lines rather than combining the days on one line.
Examples:

1A) This is an example of an incorrect billing format:

HI*ABK:F259:::::::N
HI*ABJ:F259
HI*BI:74:RD8:20241012-20241013
HI*BE: 80:29*BE:81:::2*BE:23:::903
HI*BG:C1
HCP*13*4129.93
NM1*71*1*AKIRA*ALAN****XX*1710470257
PRV*AT*PXC*2084P0800X
LX*1
SV2*0120**3300*DA*11
DTP*472*RD8*20241001-20241031 This rev code is for 11 days. The specific date ranger must be billed
LX*2
SV2*0183**214*DA*2**214
DTP*472*RD8*20241001-20241031 This rev code is for 2 days, and the occurrence span 74 shows the LOA days as 10/12/24-10/13/24, so those days should have been listed here instead of 10/01/24 – 10/31/24
LX*3
SV2*0120**5400*DA*18
DTP*472*RD8*20241001-20241031 This rev code is for 18 days. The specific date ranger must be billed

1B) This is an example of a correct billing format:

Effective October 1, 2025, submitted claims that fail this validation check will deny EXnb – DENY: R&B DAYS DO NOT EQUAL COVERAGE PERIOD*

For questions please contact Provider Services at 866-606-3700 or reach out to your Provider Engagement contact. For more information on billing requirements consult the IAMHP Billing Guide (PDF).

*CARC 16/ RARC M53