MedicaidAdministrativeHigh impact
Notice #2 - Hospital Fee-for-Service Professional Billing Transition to the Outpatient Institutional Claim Format July 1, 2020
Illinois Medicaid - HFS·IL · Emergency Medicine, Psychiatry, Oncology +6 more·Provider Notice
Effective date
Jul 1, 2020
We identified it
Jun 20, 2026
Summary
Starting July 1, 2020, Illinois hospitals must transition from professional billing (CMS-1500) to institutional billing (UB-04/837I) for all outpatient services previously billed under professional NPIs. The Ambulatory Procedures Listing (APL) is eliminated, and hospitals must use their institutional NPI instead of professional NPI for all outpatient services.
Action Required
By July 1, 2020: Billing teams at Illinois hospitals must switch from professional billing (CMS-1500) to institutional billing (UB-04/837I) for all outpatient services. Update billing systems to use institutional NPI instead of professional NPI. Split claims that cross July 1, 2020 into separate submissions. Add required revenue codes for emergency services (0450, 0456, 0451), observation services (0762), and psychiatric services (0912, 0913). Apply modifier UD for 340B drugs and therapy modifiers (GP, GO, GN) as required. Claims may be held temporarily until system testing is complete.