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Elizabeth M. Whitehorn, Director

Provider Notice Issued 02/25/2021

Date:   February 25, 2021

 

To:       Participating Hospitals:  Chief Executive Officers; Chief FinancialOfficers; and Patient Accounts Managers

 

Re:      Repricing Hospital Outpatient ClaimsBilled with COVID-19 Diagnosis and Procedure Codes

 

 

 

 

This notice informs hospitals that certainoutpatient claims containing COVID-19-related coding have been reprocessed. Theinformation below applies specifically to Medicaid fee-for-service claims;however, HealthChoice Illinois managed care planclaims have also been reprocessed so please check with your contracted MCOs ontheir individual processes.

 

By informational notice dated August 11, 2020, the Departmentsummarized two issues that allowed certain outpatient claims to group and priceincorrectly:

 

Issue #1 - Outpatient Claims with Dates ofService March 1st through May 21st, 2020 Containing DiagnosisCode U07.1 and HCPCS Codes U0001, U0002, 87635, G2023, and G2024

The Department transitioned to a new EAPG grouperversion on May 22, 2020. This EAPG grouper version includes new ICD-10diagnosis code U07.1 - COVID-19, Virus Identified (effective April 1, 2020),and additional COVID-related HCPCS codes U0001, U0002, 87635, G2023, and G2024. Claims processedprior to the new grouper version transition were impacted.

 

Issue #2 – Outpatient Claims with Dates ofService April 14th through June 30th, 2020 ContainingHCPCS Codes U0003, U0004, 86769, and 86328

These four COVID-related HCPCS codes (all effective April 14, 2020) hadnot been added to the HFS EAPG grouper. Claims already processed with thesecodes for dates of service April 14, 2020 through June 30, 2020 were impacted.  

 

On February6, 2021, theDepartment voided and reprocessed each claim potentially impacted, even ifthere was no pricing difference, in order to obtain the correct EAPG group fromthe updated version of the EAPG grouper. The voided claims are identified on the Remittance Advice with AdjustmentReason Code 5018 – EAPG Priced COVID Codes, with EAPG 0999 at $0. Theclaims were assigned new Document Control Numbers (DCNdate January 31, 2021) and reprocessed. Both the voided and reprocessedclaims appear on RemittanceAdvices dated February 6th.

 

Questions may be directed to the Bureau of Hospitaland Provider Services at 877-782-5565.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs​