MedicaidReimbursementHigh impact
Hospital Inpatient and Outpatient Reimbursement Systems
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is transitioning to new reimbursement systems for hospital claims - APR-DRG for inpatient claims effective July 1, 2013, and EAPG for outpatient claims effective January 1, 2014. Starting October 1, 2012, hospitals must report Value Code 54 with birth weight for newborn admissions or claims will be rejected.
Action Required
By October 1, 2012: Hospital billing teams must update systems to require Value Code 54 for all newborn admissions (14 days or younger), reporting birth weight in grams right-justified to the left of the dollar/cents delimiter. Update encounter forms and billing software validation rules. Claims without this value will be rejected. Prepare for transition to APR-DRG payment system for inpatient claims by July 1, 2013, and EAPG system for outpatient claims by January 1, 2014.