Provider Notice Issued 02/25/2021

Date:   February 25, 2021

 

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

 

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

 

 

This notice informs hospitals that certain outpatient claims containing COVID-19-related coding have been reprocessed. The information below applies specifically to Medicaid fee-for-service claims; however, HealthChoice Illinois managed care plan claims have also been reprocessed so please check with your contracted MCOs on their individual processes.

 

By informational notice dated August 11, 2020, the Department summarized two issues that allowed certain outpatient claims to group and price incorrectly:

 

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

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

 

Issue #2 – Outpatient Claims with Dates of Service April 14th through June 30th, 2020 Containing HCPCS Codes U0003, U0004, 86769, and 86328

These four COVID-related HCPCS codes (all effective April 14, 2020) had not been added to the HFS EAPG grouper. Claims already processed with these codes for dates of service April 14, 2020 through June 30, 2020 were impacted.  

 

On February 6, 2021, the Department voided and reprocessed each claim potentially impacted, even if there was no pricing difference, in order to obtain the correct EAPG group from the updated version of the EAPG grouper. The voided claims are identified on the Remittance Advice with Adjustment Reason Code 5018 – EAPG Priced COVID Codes, with EAPG 0999 at $0. The claims were assigned new Document Control Numbers (DCN date January 31, 2021) and reprocessed. Both the voided and reprocessed claims appear on Remittance Advices dated February 6th.

 

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

 

 

Kelly Cunningham, Administrator

Division of Medical Programs​


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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director


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