MedicaidReimbursementLow impact
Repricing Hospital Outpatient Claims Billed with COVID-19 Diagnosis and Procedure Codes
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Feb 6, 2021
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has voided and reprocessed hospital outpatient claims from March 1 - June 30, 2020 that contained COVID-19 diagnosis and procedure codes due to incorrect pricing from outdated grouper software. The reprocessed claims appear on February 6th remittance advices with new document control numbers.
Action Required
Immediately: Review February 6, 2021 remittance advices for voided claims with Adjustment Reason Code 5018 and corresponding reprocessed claims with new DCN dates of January 31, 2021. Reconcile accounts receivable to reflect correct payment amounts for COVID-19 related outpatient claims from March 1 - June 30, 2020.