MedicaidReimbursementHigh impact
Additional Information Regarding Hospital Inpatient and Outpatient Reimbursement Systems
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2014
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is implementing a new hospital reimbursement system effective July 1, 2014, transitioning from CMS-DRG to APR-DRG for inpatient claims and from APL to EAPG for outpatient claims. The change includes specialty adjusters for pediatric, trauma, and transplant services, with a 2-year transition period and $200 million support pool for hospitals with negative impacts.
Action Required
By July 1, 2014: Billing team must prepare for transition from CMS-DRG to APR-DRG system for inpatient claims and APL to EAPG for outpatient claims. Contact Illinois Medicaid via HFS Hospitals email in mid-October 2013 to request hospital-specific shadow pricing files comparing legacy to new pricing. Include hospital name, address, Medicaid Provider ID, and contact information for file delivery.