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Elizabeth M. Whitehorn, Director

Provider Notice issued 11/08/11

Chapter H-200, Handbook for Hospital Services

To:​ Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers​
​Date: ​November 8, 2011
​Re: Chapter H-200, Handbook for Hospital Services ​

Miscellaneous Updates: MCO Coverage Beginning and Ending During an Inpatient Stay; Fee-for-Service Billing for IDOC/IDJJ Inmates; Condition Code 04 Clarification; Non-Covered Revenue Code Listing

This bulletin identifies the following updates to topics in the Handbook for Hospital Services:

  • For patients beginning or ending Managed Care Organization (MCO) coverage during a DRG-reimbursed inpatient stay, the covering entity at the time of admission will be responsible for reimbursement of the entire stay. This is effective with admissions occurring on and after October 1, 2011.

  • Language regarding hospitals billing fee-for-service for professional services to IDOC/IDJJ inmates has been updated effective with dates of service on and after May 16, 2011.

  • Appendix H-2, Billing Scenario 7 contained a typographical error. Condition Code "4" has been corrected to state Condition Code "04."

  • Revenue Code 0948 has been added to the Non-Covered Revenue Code Listing in Appendix H-3. This Revenue Code was created effective October 1, 2007, but was never assigned a status within the department's database.

The Handbook for Hospital Services has been updated and is available on the department's Web site. Printed copies of this bulletin and replacement pages for the handbook are available upon written request. To ensure delivery, specify a physical street address when making a request for a paper copy. Submit your written request or fax to:

Illinois Department of Healthcare and Family Services

Provider Participation Unit

Post Office Box 19114

Springfield, Illinois 62794-9114

Fax Number (217) 557-8800

E-mail the Provider Participation Unit

Any questions regarding this bulletin should be directed to your facility's medical assistance consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Instructions for updating the Handbook for Hospital Services:

H-201.12 Fee-for-Service Categories of Service

Remove pages HFS H-201 (3-4) and insert new pages HFS 201 (3-4)

H-254.7 Claims for Illinois Department of Corrections (IDOC) and Illinois Department of Juvenile Justice (IDJJ) Inmates

Remove pages HFS H-254 (7-8, 9-10) and insert new pages HFS H-254 (7-8, 9-10)

H-260.11 Inpatient Charges for MCO Patients Whose Coverage Begins or Ends During the Inpatient Stay

Remove pages HFS H-260 (1-2) and insert new pages HFS H-260 (1-2)

Appendix H-2e Billing Scenarios

Remove pages HFS Appendix H-2e (7-8) and insert new pages HFS Appendix H-2e (7-8)

Appendix H-3 Revenue Code Information

Remove pages HFS Appendix H-3 (3-4) and insert new pages HFS Appendix H-3 (3-4)

Revised pages (pdf)