MedicaidReimbursementMedium impact
Addendum to July 25, 2011, Notice to Hospitals Adjustments Related to Cost Outlier Payment Calculation Change
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 11, 2011
We identified it
Jun 21, 2026
Summary
Illinois Department of Healthcare and Family Services is implementing adjustments to recover overpayments from hospitals due to cost outlier payment calculation changes from July 2011. Recovery will be limited to 50% offset per remittance advice and will appear with adjustment reason code 3551.
Action Required
Immediately: Hospital billing teams should expect to see adjustment reason code 3551 (Outlier Adj Re-pricing Pursuant to P.A. 97-0074) on remittance advices. Monitor that offsets do not exceed 50% of any single remittance value. Contact Bureau of Rate Development and Analysis at 217-785-0710 with questions about adjustments.