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Elizabeth M. Whitehorn, Director

Provider Notice issued 08/14/02

 

Utilization Review - Diagnosis and DRG Codes Subject to Review

​To: ​Enrolled Hospitals - Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers and Utilization Review Departments
​Date: ​August 14, 2002
​Re: ​Utilization Review - Diagnosis and DRG Codes Subject to Review

Effective with inpatient hospital admissions on or after September 16, 2002, HealthSystems of Illinois will be conducting Certification of Admission/Concurrent/Continued Stay Review on the diagnosis codes noted in Attachments A, B and C and Retrospective Prepayment Review for DRG codes in Attachment D of this notice. When a patient has an admitting diagnosis as noted in Attachment A, B or C, the hospitals must submit the request for Certification of Admission or Continued Stay (Concurrent Review) via fax, mail or telephone to the Department's Peer Review Organization (PRO), HealthSystems of Illinois (HSI).  HSI's address, phone number, fax number and website are noted below.

HealthSystems of Illinois

2050-10 Finley Road

Lombard, IL 60148

Telephone: 1-800-418-4033

Fax: 1-800-418-4039

Revised Adult and Child/Adolescent Psychiatric Review Criteria, Psychiatric Generic Quality Screen Guidelines and Detoxification Review Criteria:  A provider bulletin identifying this criteria and the review process will be sent to hospitals and will also be posted to the Department's website at  <http://www.illinois.gov/hfs/>

This notice and attachments are available on the Department's website noted above.  If you have any questions regarding this notice, please contact the Bureau of Contract Management at 217-524-7478.

Matt Powers, Administrator
Division of Medical Programs