MedicaidReimbursementMedium impact
Chapter H-200, Handbook for Hospital Services
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid revised its Provider-Preventable Conditions (PPC) policy, reducing payment by $900 for hospital-acquired conditions (HACs) instead of denying the entire admission, and implementing $0 payment for Other Provider Preventable Conditions (OPPCs) like wrong-site surgeries. The policy also updated DCFS contact information for psychiatric admissions consent.
Action Required
Immediately: Billing teams at Illinois hospitals must ensure all HAC and OPPC claims are billed as admission-through-discharge claims for proper processing. Update psychiatric admission workflows to use new DCFS Consent Unit contact (1-800-828-2179) and Child Intake and Recovery Unit (866-503-0184) for DCFS ward consents. Claims with HACs will be repriced with $900 deduction; OPPC claims will be repriced to $0.