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  • 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 05/06/2024

 

To:
 Enrolled Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Account Managers
​Date: ​May 6, 2024
​Re:
 Cease Hospital Billing on the 837P for COVID-19 Administration Performed in Hospital-Based Outpatient Settings

The Department is pleased to announce that the claims processing application has been restored as of March 23, 2024.

This notice informs hospitals that HFS is ending the policy that allowed hospitals to bill on the 837 Professional (837P) claim format for COVID-19 vaccine administration performed in hospital-based outpatient settings. This applies to claims for customers covered under both traditional fee-for-service (FFS) and HealthChoice Illinois (HCI) managed care organizations (MCOs). 

As detailed in the April 8, 2021, provider notice, HFS has reimbursed hospitals for COVID-19 vaccine administration in hospital-based outpatient settings via the 837P, as an exception to usual hospital 837 Institutional (837I) outpatient billing policy.

Effective with dates of service beginning June 1, 2024, hospitals must submit claims for COVID-19 vaccine administration on the 837I format. All currently covered COVID-19-related procedure codes are identified in the COVID-19 Fee Schedule.

Questions regarding this notice may be directed to a hospital billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

 

Kelly Cunningham, Administrator
Division of Medical Programs