This is to inform you that the department has determined that your facility is subject to the inpatient and outpatient assessments imposed on Illinois hospital inpatient and outpatient services under the provisions of 305 ILCS 5/5-A.
Enclosed are your facility’s inpatient and outpatient assessment remittance notices for fiscal year 2021 reflecting the changes to the inpatient and outpatient assessments per Public Act 101-0650
Also enclosed are tax calculation worksheets detailing the bases for the inpatient and outpatient assessments. The remittance notice has the facility’s name and address, the tax identification number and personal identification number (PIN) assigned by the department, the total amount due, and the due date.
Hospitals must remit the monthly assessments using the Illinois State Treasurer’s E-Pay Program. In order to use this service, your hospital will need an Internet connection, checking account information (bank routing number and account number), from which the payment will be made, and the hospital’s current remittance card. If your hospital is not familiar with the Illinois State Treasurer’s E-Pay Program, please contact the Bureau of Hospital and Provider Services at (217) 524-7110.
In addition, each hospital is responsible for ensuring debit authorizations can be initiated from designated accounts in the appropriate dollar amount. The following are company identification numbers to be given to your banking institution, if debit block filters are used on the hospital’s account. Please use 1810599849 or 9810599849 for these transactions.
Following are instrutctions for remitting payment:
Payment Category: Hospital Assessment
Payment Type: Hospital Assessments
Please enter the following information to identify the payment:
Account Number: HFS ID # and PIN
JetPay Authorization Number: 8 digit code provided by JetPay
Payment amount: Enter payment amount in dollars and cents
Click: Add Item and Checkout
Enter Billing Contact Information
Click: Next Step: Add Payment Method
Payment Method: eCheck
Enter payment information including bank routing number and account number
Click: Next Step: Review Payment
Check Box: I agree to the Payment Terms of Service
Click: Make Payment
Thank you for your payment notification screen may be e-mailed or printed
If you have any questions concerning this information, please do not hesitate to contact the Bureau of Hospital and Provider Services by e-mail at email@example.com, or by telephone at 217-524-7110.
Susie Brown, Interim Chief
Bureau of Hospital and Provider Services