MedicaidAdministrativeMedium impact
Utilization Review Update
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
ICD-10 diagnosis code extensions effective October 1, 2019 are now subject to inpatient utilization review for Illinois Medicaid. Specific codes R11.13 and R11.14 were added to the review list after being inadvertently omitted from a previous update.
Action Required
Immediately: Review the updated Attachment C on the Illinois HFS PRO/QIO webpage to identify all ICD-10 code extensions now subject to utilization review. Ensure inpatient admissions with these diagnosis codes undergo proper certification review through eQHealth Solutions, Inc. Contact Bureau of Hospital and Provider Services at 1-877-782-5565 with questions about specific codes requiring review.