MedicaidAdministrativeHigh impact
Hospital Rate Reform – Outpatient Claim Processing Implementation and Miscellaneous Issues
Illinois Medicaid - HFS·IL · Psychiatry, Pediatrics·Provider Notice
Effective date
Nov 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid will begin processing outpatient hospital claims using the new Enhanced Ambulatory Patient Groups (EAPG) payment system starting November 1, 2014. Extended filing deadline allows claims from July 1-October 31, 2014 to be submitted through April 30, 2015, while new billing requirements include specific revenue codes for psychiatric services and birth weight documentation for newborns.
Action Required
Immediately: Update billing systems for Illinois Medicaid outpatient claims to use EAPG payment methodology. Use Revenue Code 0912 for partial hospitalization program (PHP) claims and 0913 for intensive outpatient program (IOP) claims, both with procedure code S9480. Add Value Code 54 for all newborns 28 days or younger at admission. Verify 3M Illinois-specific EAPG software is updated to October 14, 2014 version by calling 1-800-435-7776. Submit delayed claims from July 1-October 31, 2014 by April 30, 2015 deadline.