Date: February 8, 2021
To: Enrolled Hospitals: Chief Executives Officers, Chief Financial
Officers, and Patient Accounts Managers
Re: Inpatient Delivery Claims Containing LARC
This notice informs hospitals of a payment issue for inpatient delivery claims
containing a Long Acting Reversible Contraceptive (LARC). The APR-DRG
information below applies to claims for both Medicaid fee-for-service and HealthChoice Illinois managed care plans.
Via informational notice dated June 24, 2020, the Department instructed
providers to use a LARC procedure code on the inpatient institutional claim format
for dates of service beginning July 1, 2020, to prompt an add-on payment to the
APR-DRG reimbursement. However, a system issue has prevented claims grouping to
APR-DRG 560 from receiving the
Until the system issue is corrected, claims that group to APR-DRG 560
will not receive the
add-on. The Department will notify providers by informational notice when
the issue is resolved.
Questions 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