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Enrollment in the Health Benefits for Immigrant Adults (HBIA) program will be temporarily paused effective July 1, 2023.

Enrollment in the Health Benefits for Immigrant Seniors (HBIS) program will be temporarily paused effective Nov. 6, 2023.

Provider Notice Issued 05/22/2020

Date:    May 22, 2020


To:       Enrolled Hospitals; Ambulatory Surgical Treatment Centers; Renal Dialysis Centers; Hospice Agencies; and Long Term Care Providers – Nursing Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Supportive Living Program, Medically Complex for the Developmentally Disabled Facilities, and Specialized Mental Health Rehabilitation Facilities


Re:      Use of Condition Code DR for Institutional Claims – COVID-19





This notice instructs providers to use Condition Code DR – Disaster Related, for tracking of claims potentially related to treatment of COVID-19. These instructions apply to claims for participants covered under the fee-for-service program as well as a HealthChoice Illinois managed care plan or Medicare/Medicaid Alignment Initiative (MMAI) plan.


In order to ensure appropriate flagging of COVID-19 related care, Condition Code DR must be present if an institutional claim contains one of the following ICD-10 diagnosis codes:


·         B97.29 - Other coronavirus as the cause of diseases classified elsewhere (for services provided prior to April 1, 2020)

·         U07.1 - COVID-19 (for services provided on or after April 1, 2020)

·         Z03.818 - Encounter for observation for suspected exposure to other biological agents ruled out

·         Z11.59 - Encounter for screening for other viral diseases

·         Z20.828 - Contact with and suspected exposure to other viral communicable diseases


Per National Uniform Billing Committee Guidance, Condition Code DR should be utilized for COVID-19 related care occurring for service dates beginning January 27, 2020, the date that the Department of Health and Human Services declared the COVID- 19 crisis as a federal public health emergency.


Questions regarding this notice may be directed to the Bureau of Hospital and Provider Services at 877-782-5565 or the Bureau of Long Term Care at 844-528-8444.



Kelly Cunningham

Interim Medicaid Administrator