Date: December 30, 2020
To: Illinois Hospital Providers
Re: February through June 2021 Hospital Provider Assessment Adjustment
This is to inform you that the department has conducted the final adjustment of the February through June 2021 Hospital Provider Assessments pursuant to 305 ILCS 5/5A-2(b-7)(2). The final adjustment is based on the inpatient and outpatient payments scheduled for payment during July 2020 through December 2020.
Enclosed are the facility’s inpatient and outpatient remittance notices for February through June 2021 reflecting the inpatient and outpatient adjustments per Public Act 101-0650. The first adjusted remittance is due February 25, 2021 for the February 2021 assessment.
Hospitals must remit the adjusted February through June 2021 assessment payments 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 Rate Development and Analysis 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 instructions 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 contact the Bureau of Rate Development and Analysis by e-mail at email@example.com, or by telephone at 217-524-7110.
Kathleen Staley, Chief
Bureau of Rate Development and Analysis