MedicaidPrior AuthHigh impact
Changes to Utilization Review
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Mar 1, 2007
We identified it
Jun 21, 2026
Summary
Illinois Medicaid is implementing mandatory concurrent review (certification of admission and continued stay review) for specific diagnoses starting March 1, 2007, with full enforcement beginning June 1, 2007. Claims without proper certification will be rejected with error code A88 and will not be payable.
Action Required
By March 1, 2007: Hospital billing teams must implement concurrent review processes for all diagnoses listed in Attachments A, B, and C on the HFS website. By June 1, 2007: Ensure 100% compliance with mandatory concurrent review or claims will receive error code A88 and be rejected. Submit exception claims with cover memos to assigned billing consultants for manual review. Monitor that no more than 10% of reviews require retrospective review to avoid penalties.