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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/02/06

Utilization Review – Revisions to Concurrent Review Procedures

​To: ​Participating Hospitals: Chief Executive Officers, Chief Financial Officers, Patient Accounts Managers, and Utilization Review Departments
​Date: ​February 2, 2006
​Re: ​Utilization Review – Revisions to Concurrent Review Procedures

Effective with admission dates on and after January 1, 2006, the Department of Healthcare and Family Services’ Quality Improvement Organization, HealthSystems of Illinois (HSI), is revising utilization review procedures related to short inpatient stays and concurrent review for additional days after discharge.

Concurrent Review Related to Admission
Hospitalswill be allowed the opportunity to request a concurrent review related to an admission for a short-term stay (three days or less) after the participant has been discharged. HSI will only accept these requests for concurrent review related to admission if requests are submitted using HSI’s Web-based review request system within seven days of discharge.

Concurrent Review After Discharge

Hospitals will be allowed the opportunity to submit a concurrent review request for hospitalizations after 30 days of the participant’s discharge, as long as the admission has been certified by HSI. The request must be submitted to and approved by HSI and any claim for payment must be received by the department within the department’s claim submission timeframe; i.e., no later than 12 months from the “Through” date of service on the claim.

The concurrent review procedures identified in this notice are located on HSI’s Web site. This notice is also located on the department’s Web site at <http://www.hfs.illinois.gov/hospitals/>.

Providers wishing to receive e-mail notification, when new provider information has been posted by the department, may register at the following HFS Web site:

http://www.hfs.illinois.gov/provrel

Electronic claim submission via the Internet is available by registering on the department’s Medical Electronic Data Interchange, Internet Electronic Claims (MEDI/IEC) System at: <http://www.myhfs.illinois.gov/>. The MEDI/IEC System is available to enrolled providers and their authorized staff, claim submitting agents and payees. During the registration process, you will be given access to specific claim formats based upon your enrollment status with the department.

Any questions regarding this notice may be directed to the Bureau of Maternal and Child Health Promotion at 217-524-7478.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs