Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 06/19/14

Final Hospital Inpatient and Outpatient Rates / 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 19, 2014
​Re: Final Hospital Inpatient and Outpatient Rates / Calculators for Claims Pricing Effective 7/1/14​

Pursuant to Public Act 98-0651 and the administrative rules pertaining to hospital rate reform as approved for adoption by the Joint Committee on Administrative Rules on June 17, 2014, this serves as notification to hospitals that the rates effective July 1, 2014 for inpatient dates of discharge and outpatient dates of service have been posted to the Department’s rate reform website. Updated inpatient and outpatient pricing calculators containing the final rates have replaced the versions that were posted on June 5, 2014. These updated calculators provide each hospital with its inpatient rates, both APR-DRG base rate and specialty per diem rates, and outpatient rates. In addition to the rates published through the pricing calculators, the Department will be mailing individualized rate sheets to each hospital in the near future.

As with the previous versions, 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, MHVA, or the newly created Safety Net and Psychiatric add-ons.

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 accessed on the HFS Hospital Rate Reform Initiative web page.

 

Dan Jenkins, Chief

Bureau of Rate Development and Analysis