MedicaidAdministrativeMedium impact
Attachment C Utilization Review Update for July 1, 2013
Illinois Medicaid - HFS·IL · Internal Medicine, Neurology, Orthopedics +2 more·Provider Notice
Effective date
Jul 1, 2013
We identified it
Jun 20, 2026
Summary
Six new diagnosis codes (including anemia, epilepsy, osteoarthrosis, shortness of breath, nausea with vomiting, and vomiting alone) will be subject to mandatory concurrent utilization review for inpatient admissions. This Illinois Medicaid policy requires additional review processes for patients admitted with these specific diagnoses.
Action Required
By July 1, 2013: Billing and utilization review teams must implement mandatory concurrent review processes for admissions with diagnosis codes 285.9, 345.90, 715.36, 786.05, 787.01, and 787.03. Contact eQHealth Solutions at 1-800-418-4045 for review process questions and ensure compliance with utilization review requirements to avoid claim denials.