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
