MedicaidReimbursementMedium impact
Change to Cost Outlier Payment Calculation Retroactive to January 1, 2011
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2011
We identified it
Jun 21, 2026
Summary
Illinois Medicaid has changed the cost outlier payment calculation for DRG-reimbursed hospital services, multiplying the Specific Fixed Loss Threshold by 1.99 for admissions on or after January 1, 2011. The department will automatically adjust affected paid claims from January 1, 2011 through June 16, 2011.
Action Required
No immediate action required from billing teams. The Illinois Medicaid department will automatically adjust affected claims with admission dates from January 1, 2011 through June 16, 2011. Monitor claim adjustments and contact the Bureau of Comprehensive Health Services at 1-877-782-5565 with questions about cost outlier calculations.