MedicaidDocumentationMedium impact
InterQual Criteria
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
May 12, 2004
We identified it
Jun 21, 2026
Summary
HealthSystems of Illinois (HSI) will now use the most current InterQual Criteria (2003 version) to determine medical necessity for inpatient hospital admissions and continued stay reviews for medical/surgical diagnoses. HSI will notify providers via bulletin when new versions are released annually in Q2.
Action Required
Immediately: Hospital utilization review departments must ensure compliance with InterQual Criteria 2003 for all inpatient medical/surgical admission determinations. Monitor HSI website and provider bulletins for annual updates typically released in Q2. Contact Bureau of Contract Management at 217-524-7478 with questions.