MedicaidAdministrativeHigh impact
Hospital Professional Billing Transition to the Outpatient Institutional Claim Format July 1, 2020
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2020
We identified it
Jun 20, 2026
Summary
Illinois hospitals must transition all outpatient professional billing to institutional claim format (837I/UB-04) and use institutional NPIs instead of professional NPIs. The Ambulatory Procedures Listing (APL) is being eliminated, requiring all outpatient services to be billed as institutional services.
Action Required
By July 1, 2020: Hospital billing teams must switch all outpatient professional services to institutional billing format using 837I electronic transactions or UB-04 paper forms. Update billing system to use institutional NPI for all outpatient services and stop using professional service NPIs. Remove APL procedures from professional billing workflows as all outpatient services now follow institutional billing rules.