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Chapter H-200, Handbook for Hospital Services Non-Payment for Provider-Preventable Conditions (PPCs)
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2012
We identified it
Jun 20, 2026
Summary
Illinois Medicaid will deny payment for entire inpatient hospital stays when Provider-Preventable Conditions (PPCs) occur during admission, including Hospital-Acquired Conditions and wrong-site surgeries. Hospitals must submit claims with specific diagnosis codes and Present on Admission (POA) indicators, but will receive zero payment for these preventable conditions.
Action Required
By July 1, 2012: Hospital billing teams must ensure all inpatient claims include required Present on Admission (POA) indicators for designated diagnosis codes. Update billing systems to submit claims for Provider-Preventable Conditions with appropriate secondary E-codes (E876.5, E876.6, E876.7) and POA indicators, understanding these claims will be paid at zero. Train coding staff on new HAC requirements and OPPC reporting procedures to avoid claim rejections with error code H25.