MedicaidPrior AuthHigh impact
Changes to Utilization Reviews/Inpatient Detoxification Readmissions
Illinois Medicaid - HFS·IL · Psychiatry, Internal Medicine, Emergency Medicine·Provider Notice
Effective date
Jul 9, 2012
We identified it
Jun 20, 2026
Summary
Effective July 9, 2012, Illinois Medicaid implements a 60-day readmission restriction for inpatient detoxification services - patients cannot be approved for reimbursement if they had a previous inpatient detox stay within 60 days. Hospitals must use the new eQHealth Look-Up utility to check eligibility before admission and contact eQHealth within 24 hours for concurrent review.
Action Required
By July 9, 2012: Billing team must access eQHealth's eQSuite system to use the new Detoxification Look-Up utility before any inpatient detox admission to verify patient eligibility. Hospital staff must contact eQHealth within 24 hours or next business day of admission for concurrent review. Obtain eQSuite access from eQHealth Web Administrator if needed. Claims will be denied if patient had previous inpatient detox stay within 60 days.