Agencies
Services
Provider Notice issued 06/05/14
Hospital Inpatient and Outpatient Calculators for Claims Pricing Effective 7/1/14
| To: | Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers; and Ambulatory Surgical Treatment Centers |
| Date: | June 5, 2014 |
| Re: | Hospital Inpatient and Outpatient Calculators for Claims Pricing Effective 7/1/14 |
The Department has posted inpatient and outpatient claims calculators on the Hospital Rate Reform webpage. These calculators are considered DRAFT until the rate reform rules are adopted. The Department, however, recognizes the importance of providing the most up to date information to hospitals to assist in their preparation for the implementation of the new systems July 1.
These calculators contain the list of APR-DRGs / EAPGs and their relative weights and will display all rate components needed for each individual hospital to determine estimated claim payment for a given claim on the ‘Interactive Calculator’ tab. The calculators do not determine the APR-DRG or EAPG assigned to a claim – that information must be entered into the calculator. Also, the calculators are only estimating base pricing and do not account for add on payments such as DSH, MPA, or MHVA.
The calculators have a tab titled ‘Calculator Instructions’ which guide the user through the ‘Interactive Calculator’ tab. Each hospital will need to enter in cell E10 in the APR-DRG Calculator and cell E6 in the EAPG Calculator, their 12 digit provider ID that is assigned by the Department. If you need assistance in obtaining the correct 12 digit ID for your facility, please email HFS.Hospitals@illinois.gov. Provider ID’s will only be sent to individuals whose email addresses are identifiable with the provider for which they are requesting the information.
The calculators can be found on the Hospital Rate Reform Initiative web page.
Dan Jenkins, Chief
Bureau of Rate Development and Analysis