MedicaidReimbursementHigh impact
Hospital Rate Reform Effective with Inpatient Discharges and Outpatient Dates of Service Beginning July 1, 2014
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is implementing major hospital rate reforms effective July 1, 2014, transitioning to APR-DRG payment system for inpatient claims and EAPG system for outpatient claims. This affects all hospital billing processes, claim submission requirements, and reimbursement calculations for Illinois Medicaid patients.
Action Required
By July 1, 2014: Hospital billing teams must update systems to process inpatient claims under APR-DRG Grouper Version 30 and outpatient claims under EAPG Grouper Version 3.7. Void all interim claims with dates prior to July 1st and rebill as complete admission-through-discharge claims. Add required Value Code 54 for newborn birth weight reporting. Update outpatient claim forms to include Service Date in FL 45 and ensure observation services include both Revenue Code 0762 with associated HCPCS and separate 0762 line with G0378. Claims not meeting new requirements will be rejected.