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Elizabeth M. Whitehorn, Director

Provider Notice issued 10/02/2024

 

To: Enrolled Hospitals:  Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers
​Date October 2, 2024
​Re:
 Outpatient Adjustments Related to EAPG Software Issue

This notice informs hospitals of upcoming adjustments for outpatient claims that were priced incorrectly due to a software issue. This issue applies only to Medicaid fee-for-service (FFS) claims.

The Department of Healthcare and Family Services (HFS) has been made aware of a change to a default setting in the August 1, 2023, hospital outpatient Enhanced Ambulatory Patient Grouping (EAPG) software from 3M/Solventum. This change only impacted the mainframe application used by HFS for pricing FFS, multi-day, emergency room and observation claims. The change resulted in additional discounting of some procedure revenue lines that historically were not discounted.

The Department is updating its system and will isolate all impacted claims and apply adjustments accordingly. There is no action necessary by hospital providers. As the change only impacted the mainframe software, entities using 3M/Solventum’s non-mainframe software are not impacted.

Questions regarding this notice may be directed to the Bureau of Rate Development and Analysis at (217) 785‑0710 or by email at hfs.hospitals@illinois.gov.

 

 

Kelly Cunningham, Administrator
Division of Medical Programs