MedicaidDocumentationMedium impact
Provider Quality Assurance Participation
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Mar 19, 2019
We identified it
Jun 20, 2026
Summary
Illinois Medicaid managed care organizations (MCOs) will request medical records from providers to verify HEDIS quality measures when services cannot be identified through claim coding. Providers can reduce record requests by using appropriate billing codes when documenting and billing for preventive care and quality measures throughout the year.
Action Required
Ongoing: Billing team must ensure all applicable and appropriate codes are used when evaluating and billing Medicaid patients to reduce medical record requests from MCOs. Review HFS fee schedules on the Medicaid Reimbursement webpage for covered procedures that document HEDIS compliance. Cooperate with MCO medical record requests as required by network contracts.