MedicaidAdministrativeMedium impact
Utilization Review – Deletion of Diagnosis and DRG Codes Subject to Review
Illinois Medicaid - HFS·IL · Pulmonology, Orthopedics, Oncology +1 more·Provider Notice
Effective date
May 1, 2005
We identified it
Jun 21, 2026
Summary
HealthSystems of Illinois is removing certain diagnosis and DRG codes from utilization review requirements due to low denial rates. This means less administrative burden for affected codes as they will no longer require concurrent or prepayment review.
Action Required
By May 1, 2005: Billing team should update internal processes to reflect that diagnosis codes 518.81, 518.82, and 821.01, along with DRG codes 098 and 410, no longer require utilization review documentation for HealthSystems of Illinois. Remove any internal flags or special handling procedures for these codes when billing this payer.