MedicaidReimbursementHigh impact
New Outpatient EAPG Grouper Version and Updates to Hospital Reimbursement Components Effective January 1, 2017
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2017
We identified it
Jun 20, 2026
Summary
Illinois Medicaid updated their outpatient payment system to EAPG Grouper Version 3.11 and modified hospital reimbursement components including wage indices and cost-to-charge ratios. All inpatient and outpatient claims with dates of service January 1, 2017 and after will be temporarily held until the new payment system is fully tested.
Action Required
Immediately: Expect temporary processing delays for all Illinois Medicaid inpatient and outpatient claims with dates of service January 1, 2017 and after due to payment system testing. Monitor for release of new hospital rate sheets and payment calculators on the Illinois Department of Healthcare and Family Services website. Contact Bureau of Rate Development and Analysis at 217-785-0710 for questions about payment delays.