MedicaidAdministrativeMedium impact
Utilization Review Changes Effective for Admissions On and After October 1, 2013
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 1, 2013
We identified it
Jun 20, 2026
Summary
Effective October 1, 2013, Illinois Medicaid implemented new retrospective prepayment review requirements for one-day inpatient stays using specific admitting diagnosis codes (Attachment E). Claims meeting criteria will suspend for review by eQHealth Solutions, and may be denied if not approved.
Action Required
By October 1, 2013: Hospital billing teams must prepare for new one-day stay review process. Monitor claims with general inpatient services (category 20) for one-day stays that will suspend with F76 code for eQHealth Solutions review. Download new Attachment E diagnosis code list from the department's QIO website. Contact eQHealth Solutions at 1-800-418-4045 for review process questions. Claims denied will reject with P68 code.