MedicaidBilling CodesMedium impact
Inclusion of Medicare HMO Services for Disproportionate Share Calculation
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2004
We identified it
Jun 21, 2026
Summary
Hospitals can now bill Medicaid for Medicare HMO patients at zero payment to include these inpatient days in disproportionate share calculations. This requires submitting special institutional Medicare/Medicaid crossover claims with specific condition codes and value codes.
Action Required
Immediately: Billing team must submit institutional Medicare/Medicaid crossover claims for patients with both Medicaid and Medicare HMO coverage. Include Condition Code '4' (Information Only Bill) and appropriate Value Code with amount '0.00' (e.g., Value Code 'A1' if Medicare Payer line is A). Bill all applicable inpatient services retroactive to beginning of fiscal year 2004 to be considered for disproportionate share determination for rate year 2007.