MedicaidPrior AuthMedium impact
Utilization Review - Diagnosis and DRG Codes Subject to Review
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Sep 16, 2002
We identified it
Jun 21, 2026
Summary
HealthSystems of Illinois will begin conducting utilization review for specific diagnosis codes and DRG codes for hospital admissions. Hospitals must submit certification requests to HSI for patients with certain admitting diagnoses, and some DRG codes will undergo retrospective prepayment review.
Action Required
By September 16, 2002: Hospital billing teams must establish process to submit Certification of Admission/Concurrent/Continued Stay Review requests to HealthSystems of Illinois via fax (1-800-418-4039), mail, or phone (1-800-418-4033) for patients with admitting diagnoses listed in Attachments A, B, and C. Update admission workflows to identify these diagnosis codes and trigger review requests.