MedicaidAdministrativeMedium impact
Illinois Health Connect Urgent Care Referral Policy for Phase I
Illinois Medicaid - HFS·IL · Family Medicine, General Practice, Internal Medicine·Provider Notice
Effective date
Jan 28, 2010
We identified it
Jun 21, 2026
Summary
Illinois Health Connect clarifies that PCPs can provide services at urgent care facilities without referrals during Phase I implementation, but only under specific conditions including being salaried/contracted by the facility and working outside regular hours. Claims must use Place of Service Code 20 for urgent care facility.
Action Required
Immediately: Billing team must ensure Illinois Health Connect PCP claims for urgent care services use Place of Service (POS) Code 20 when PCPs are salaried/contracted by urgent care facilities and providing services outside regular hours. Update billing system to support POS Code 20 for both paper claims and 837P electronic format. Providers must educate enrollees about medical home importance and notify the enrollee's IHC PCP about urgent care visits including date and reason.