MedicaidPrior AuthHigh impact
Inpatient Utilization Review Update
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 (prior authorization) for inpatient admissions with specific diagnosis codes starting March 1, 2007. Several diagnosis codes are being removed from review requirements, while new codes are being added and all reviews will move to offsite-only.
Action Required
By March 1, 2007: Illinois hospitals must implement mandatory concurrent review for all inpatient admissions with diagnosis codes on Attachments A, B, and C. Contact HSI via web portal or call 800-418-4033 for certification. Submit medical records to HSI for all retrospective reviews (offsite only). For stays 3 days or fewer, submit review requests within 7 days of discharge via HSI's web system. Claims will be rejected without proper concurrent review certification.