MedicaidPrior AuthHigh impact
Clarification of Prior Approval and Billing Instructions
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Apr 1, 2004
We identified it
Jun 21, 2026
Summary
Home health agencies must now obtain prior approval when billing for more than one skilled nursing visit on the same date within 60 days of hospital discharge, with specific billing format requirements depending on electronic vs paper submission. Additionally, effective April 1, 2004, local codes are eliminated and HCPCS codes are now required for all home health services.
Action Required
Immediately: Home health billing teams must update workflows to require prior approval requests for multiple skilled nursing visits per day within 60 days of hospital discharge. For electronic claims, omit discharge date from Loop ID 2300 HI and enter visit count in Loop ID 2400 SV205. For paper claims using DPA 2212, omit discharge date from Box 10 and show total visits in units box. Replace all local codes with HCPCS codes in billing system. Contact software vendor to ensure system supports these requirements.