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Fee Schedule and Program Changes

Fee Schedule and/or Program Changes: When Meridian receives a fee schedule update or program change from HFS, we will load the change to the claim system as quickly as possible. See below for loading schedule. At times Meridian will receive a fee schedule or program change after the effective date. Providers do not need to request reprocessing of claims as Meridian will automatically reprocess all impacted claims once the change is loaded into the claims system. Interest will apply to claims reprocessed more than 45 days after the notification of the change. Claims with billed charges less than the published charge will not be reprocessed. Providers should always bill with usual and customary charges to avoid this situation.

 

Production Status
In-ProgressSystem is currently being updated to reflect change
CompletedSystem is updated to pay claims per the HFS fee schedule or program change
No Updates NeededSystem is already configured to pay per HFS fee schedule or program change

 

 Claim Adjustment Status

 

 
PendingClaims reprocessing has not begun 
In ProgressClaims to reprocess based on HFS fee schedule or program change have been identified and a project submitted 
CompletedClaims reprocessing is complete 
N/ASystem was updated prior to receiving claims. No reprocessing needed 



Fee Schedule Updates and Program Changes

TitleDate Received from HFSEffective DateProduction StatusCompletion Date of ProductionClaims Adjustment Status and/or Completion Date
MCO ACCOUNT MANAGER: 01.01.2025 SNF/SMHRF/SLP MCO Rates Updated3/17/20251/1/2025In-Progress Pending
2025 MPA MHVA Final Rates effective 01/01/2025 Updated 3.14.20253/6/20251/1/2025In-Progress Pending
Supportive Living Program Rates Effective January 1, 20253/3/20251/1/2025Completed3/4/2025In-Progress
Medicaid Rate List for Nursing Facilities, County Nursing Facilities, and SMHRFs Effective January 1, 20253/3/20251/1/2025Completed3/11/2025In-Progress
Licensed Certified Professional Midwives Add-on Payment2/24/20253/1/2025In-Progress Pending
Nursing Facility Per Diem Rate Notices - Capital Rate Changes due to Tax Updates 12.18.242/10/202512/1/2024No Updates N/A
2025 Renal Dialysis Rates2/3/2025VariesCompleted3/17/2025In-Progress
Revised APR-DRG and EAPG Hospital Rate Calculators2/3/20251/1/2025No Updates N/A
CCBHC PPS Rates Heritage Behavioral Health Center1/16/202510/1/2024Completed1/7/2025Completed
Revised Provider ID for OSF1/10/20251/1/2024No Updates N/A
Certified Community Behavioral Health Clinics (CCBHC) Fee Schedule - Updated1/9/202510/1/2024Completed1/7/2025Completed
Updated School Based/Linked Health Center Fee Schedule1/9/202510/1/2025Completed1/7/2025Completed
Updated Podiatry Fee Schedule effective 10/1/241/9/202510/1/2025Completed1/16/2025In-Progress
Updated 12.31.2024 Practitioner and Family Planning Fee Schedules 01.06.20251/9/20251/1/2024No Updates N/A
2025 MPA MHVA Final Rates effective 01/01/20251/6/20251/1/2025Completed2/6/2025Completed
Nursing Facility Per Diem Rate Notices - Capital Rate Changes due to Tax Updates 12.18.2412/30/2024VariesCompleted1/2/2025Completed
Rural Health Clinics CY25 Rate List with NPI12/30/20241/1/2025Completed1/13/2024Completed
Coverage of Human Papillomavirus (HPV) Vaccination Ages 46 and Up per Public Act 103-010212/27/20241/1/2025No Updates N/A
2025 MPA MHVA Final Rates effective 01/01/202512/26/20241/1/2025Completed2/6/2025Completed
Cook County Hospitals and University of Illinois Hospitals 1.1.25 Rates12/23/20241/1/2025Completed1/20/2025In-Progress
Nursing Facility Per Diem Rate Notices - due to appeals12/19/2024VariesCompleted12/17/2024Completed
01/01/25 INH Rate Increase (In- Home Rate)12/18/20241/1/2025Completed11/4/2024N/A
10% Hospital Rate Increase Update12/17/20241/1/2024Completed1/29/2025Completed
School Based Health Services Fee Schedule Effective 10/01/2024 Updated 12/11/202412/11/202410/1/2024Completed12/25/2025Completed
Podiatrist Fee Schedule effective 10/01/2024 updated 12/11/2024 & 1/9/202512/11/202410/1/2024Completed1/16/2025In-Progress
CY 2025 FQHC rates for MCOs12/11/20241/1/2025Completed1/9/2025Completed
Nursing Facility Per Diem Rate Notices: ILLINI HERITAGE REHAB AND HC12/10/2024VariesNo Updates N/A
Updated Community-Based Behavioral Health Fee Schedule and Billing Guidance12/9/20248/1/2024Completed12/18/2024Completed
Practitioner Fee Schedule Effective 10/01/2024 Updated 12/06/202412/6/202410/1/2024Completed12/30/2024Completed
Nursing Facility Per Diem Rate Notices - Brookdale Plaza Lisle Eff 01/01/24 Updated Rate 12.10.202412/6/20241/1/2024Completed12/17/2024N/A
Revised APR-DRG and EAPG Hospital Rate Calculators - Effective 1.1.202512/4/20241/1/2025Completed12/26/2024Completed
Family Planning Program Fee Schedule Updated 11/25/202411/25/2024VariesNo Updates N/A
Updated Practitioner Fee Schedule and Fee Schedule Key for 07/01/202411/18/20247/1/2024Completed1/16/2024Completed
MPA and MHVA Rate BJC and Christian Hospital11/14/202410/1/2022Completed11/29/2023Completed
Updated Practitioner Fee Schedule and PFS Key effective 7/1/202411/6/20247/1/2024Completed12/4/2024N/A
Revised Rate Sheet - SouthEast Behavioral Hospital10/31/20241/1/2024Completed N/A
7/1/24 SNF/SMHRF/SLP MCO Rates10/25/20247/1/2024Completed11/12/2024Completed
Hospice Annual Rate Changes Effective October 1, 202410/18/202410/1/2024Completed10/24/2024Completed
Upcoming Rate Increases DRS and Elderly Waivers Updated Correction 10/23/202410/17/20241/1/2025Completed11/4/2024N/A
Lactation Counseling Services Fee Schedule10/11/20241/1/2024Completed12/31/2024N/A
Doula Fee Schedule10/11/20242/1/2024Completed11/22/2024N/A
$113 add-on for Outpatient Psychiatric Claims8/24/20231/1/2023In Progress Pending

TitleDated Received from HFSEffective DateProduction StatusCompletion Date of ProductionClaims Adjustment Status and/or Completion Date
Updated Podiatry Fee Schedule10/10/20247/1/2024No Updates N/A
SUPR/ DASA Rates10/8/20247/1/2024Completed10/8/2024N/A
Updated CCBHC Rates10/3/202410/1/2024Completed10/3/2024N/A
Nursing Facility Per Diem Rate Notices
Updated Notice 10.7.2024, 10.11.2024		10/3/2024VariesCompleted Completed
School Based Health Services Fee Schedule Effective 07/01/2024 Updated 09/27/20249/30/20247/1/2024No Updates N/A
7/1/24 & 4.1.2024 updated Practitioner Fee Schedule
Updated Fee Schedule 9.27.2024		9/20/20247/1/2024Completed10/4/2024Completed
Updated C19 Fee Schedule9/20/2024VariesNo Updates N/A
CCBHC Provider Enrollment and Rate Information9/17/202410/1/2024Completed9/26/2024N/A
Upcoming Rate Increases DRS and Elderly Waivers9/9/20241/1/2025Completed9/20/2024N/A
Capital Rate Updates and Tax Rate Changes8/23/2024VariesCompleted9/9/2024Completed
Updated C19 fee schedule eff 4.1.248/2/20244/1/2024Completed8/16/2024N/A
Updated Therapy fee schedule eff 1.1.248/2/20241/1/2024No Updates N/A
New Safety Net Add-on Payments effective 7-1-2024 (updated)7/26/20247/1/2024Completed8/6/2024Completed
Updated Pathways to Success Rates7/22/20248/1/2024Completed10/3/2024Completed
Lab Rates eff 4.1.247/22/20244/1/2024Completed3/28/2024N/A
4.1.24 Pharmacist fee schedule with PRU7/19/20244/1/2024Completed8/20/2024N/A
7/1/24 SNF/SMHRF/SLP MCO Rates7/19/20247/1/2024Completed7/30/2024N/A
Updated Audiology Fee Schedule7/19/20244/1/2024Completed8/6/2024Completed
SBHC fee schedule eff 4.1.247/19/20244/1/2024Completed8/9/2024Completed
Podiatric Fee Schedule eff 4.1.247/19/20244/1/2024Completed8/19/2024Completed
LPHA fee schedule with PRU7/19/20244/1/2024Completed3/27/2024N/A
Hospital Rate Sheet and Other Add On Rates for Montrose Behavioral Hospital - Adult Facility7/12/20241/1/2024Completed7/15/2024Completed
Revised 8/1/2023 Hospital Outpatient EAPG Calculator7/8/20248/1/2023No Updates N/A
DRS Rate Increases and SCM increases approved for 8/1/246/24/20248/1/2024Completed7/18/2024N/A
SUPR Rates6/12/20247/1/2024Completed6/14/2024N/A
New Safety Net Add-on Payments effective 7/1/20246/11/20247/1/2024Completed6/24/2024N/A
Air & Ground Ambulance Rates5/17/20241/1/2024Completed5/29/2024Completed
LTC - Warren Barr Lieberman 4/1/2024 Rate Sheet5/14/20244/1/2024Completed5/17/2024N/A
Transcervical Fibroid Ablation (TFA) Coverage effective 1/1/20245/29/20241/1/2024Completed8/16/2024N/A
4/1/24 SNH/SMHRF/SLP MCO Rates4/26/20244/1/2024Completed4/24/2024N/A
COVID-19 Fee Schedule 4/24/20244/24/2024VariesCompleted3/20/2024Completed
Ventilator Enhanced Rate4/24/20241/1/2024Completed6/16/2024Completed
Breast Cancer Screening Rates + add-on4/24/20244/1/2024Completed7/13/2024Completed
Lactation Support Services - Update4/11/20241/1/2024Completed6/16/2024N/A
Updated IDoA Enhanced Rate Providers3/28/2024VariesCompleted4/2/2024N/A
New Practitioner Fee Schedule3/13/20244/1/2024Completed3/28/2024N/A
Updated CBS Fee Schedule Effective 1/1/20243/5/20241/1/2024Completed2/26/2024N/A
Electric Breast Pump Change in Benefit Frequency Without Prior Approval3/4/20241/1/2024Completed4/25/2024Completed
Peristeen Plus A44592/29/20241/1/2024Completed3/29/2024Completed
DSH MPA and MHVA Rates for 1/1/2024 - Update2/29/20241/1/2024Completed2/29/2024Completed
Practitioner Fee Schedule Effective 1/1/2024 Updated 2/27/20242/28/20241/1/2024Completed3/20/2024Completed
Updated SBHC Fee Schedule2/27/20241/1/2024Completed3/8/2024N/A
Updated Audiology Fee Schedule2/27/20241/1/2024Completed3/14/2024Completed
Lactation Support Services - Updated Fee Schedule2/26/20241/1/2024Completed6/16/2024Completed
SUPR Rates Updated2/23/20241/1/2024Completed3/1/2024Completed
New DME Rates Effective 1/1/20242/21/20241/1/2024Completed3/14/2024Completed
Implement COVID-19 Vaccine Administration Rate Change - by March 1, 20242/16/20243/1/2024Completed3/20/2024Completed
HIV/AIDS Waiver - Rate Increases Effective February 9th2/7/20242/9/2024Completed2/15/2024Completed
New EHRS Modifier1/30/20242/1/2024Completed2/29/2024N/A
NF and SLP Rate Updates1/30/20241/1/2024Completed2/8/2024N/A
EHRS Implementation - CCUs & EHRS1/16/20242/1/2024No Updates N/A
Final Practitioner Fee Schedule for 20231/10/202412/31/2023Completed3/1/2024N/A
Updated FP (Family Planning) Fee Schedule12/26/2023VariesNo Updates N/A
DSH MPA and MHVA Rates for 1/1/202412/19/20231/1/2024Completed2/9/2024Completed
Updated Practitioner Fee Schedule Effective 10/1/202312/14/202310/1/2023Completed12/19/2023Completed
CMHC Rates 1/1/202412/5/20231/1/2024Completed12/27/2023N/A
Revised Hospital Inpatient and Outpatient Calculators Effective 1/1/202412/1/20231/1/2024Completed12/19/2023N/A
Home Health Rates 1/1/202411/13/20231/1/2024Completed1/2/2024N/A
Renal Dialysis Rates and Provider Updates10/30/2023VariesCompleted12/1/2023Completed
SUPR Rate Sheet FY2410/27/20231/1/2024Completed10/11/2023N/A
LTC Rates 10/1/202310/24/202310/1/1023Completed11/1/2023N/A
NF & SLP Rates 10/1/202310/23/202310/1/2023Completed10/16/2023N/A
FQHC/RHC Rates 1/1/202410/20/20231/1/2024Completed11/6/2023N/A
Coverage of Acupuncture Services per Public Act 102-103710/18/20234/1/2023Completed1/16/2024Completed
COVID-19 Fee Schedule Updates 9/15 & 10/22 Correction Came in 10/27/2310/17/2023VariesCompleted11/1/2023N/A
Updated Practitioner Fee Schedule, Key and Modifier Listing10/4/202310/1/2023Completed10/26/2023Completed
Maternity Care Billing, Transition to Global Rates10/2/202310/1/2023Completed10/26/2023Completed
Revised Inpatient and Outpatient Calculators Effective 10/1/202310/2/202310/1/2023No Updates N/A
SBHC Fee Schedule Update Ready for Posting9/28/20237/1/2023Completed10/10/2023N/A
Fiscal Year 2024 Safety Net Obstetrical Payment Program9/26/2023VariesCompleted1/9/2024N/A
SUPR Rate Sheet FY24 Updated 9/26/20239/22/2023VariesCompleted10/11/2023N/A
7/1/2023 Practitioner Fee Schedule9/13/20237/1/2023Completed9/20/2023Completed
Reminder to MCO's for Psych add on Payment for Certain Hospitals9/1/2023VariesCompleted9/14/2023Completed
Correct Outpatient Rates for Javon Bea Hospital8/24/2023VariesNo Updates N/A
Final 1/1/2023 Calculators and Rate Sheets for UHS Hospitals (IP/OP Hosp. Calculators EAPG & APR-DRG 1/1/23 - 7/31/23)8/23/20231/1/2023Completed9/19/2023N/A
Policy/Billing Change Effective 1/1/2024 CPT 994838/21/20231/1/2024Completed9/5/2023N/A
ICF/IID
and MC/DD Rate Changes Effective January 1, 2023		8/17/20231/1/2023Completed8/1/2023N/A
Maternity
Care Reimbursment Changes Effective 10/1/2023		8/15/202310/1/2023No
Updates		 N/A
Pharmacists
Billing for HIV Pre- and Post-Exposure Prophylaxis Assessment and
Consultation per Public Act 102-1051		8/9/20231/1/2023Completed9/14/2023Completed
HCBS Rate Increases Effective 1/1/20248/9/20231/1/2024Completed8/21/2023N/A
Revised Outpatient EAPG Hospital Calculator - Updated8/1/20238/1/2023Completed8/16/2023Completed
B4105 - RELiZORB Pricing Increase7/28/20236/1/2023Completed7/31/2023N/A
Renal Dialysis Rates and Provider Updates7/28/2023VariesCompleted8/10/2023N/A
Rate Increase for Breast Tomosynthesis Procedures Effective 1/1/2023 per Public Act 102-10187/18/20231/1/2023Completed7/18/2023Completed
Revised IP and OP Calculators Effective 8/1/2023 - With Updates7/18/20238/1/2023Completed8/16/2023Completed
Revised IP and OP Calculators Effective 8/1/2023 - With Updates7/12/20238/1/2023Completed8/16/2023Completed
NF & SLP Rates - 7/1/20237/6/20237/1/2023Completed7/6/2023N/A
Practitioner Fee Schedule and Updated Key - Effective 4/1/20236/20/20234/1/2023Completed7/19/2023Completed
Podiatric Fee Schedule - Effective 4/1/20236/20/20234/1/2023Completed7/18/2023N/A
Practitioner Fee Schedule - Effective 1/1/2023 Updated 3/15/20236/6/20231/1/2023No Updates N/A
Long Acting Injectables - Effective 7/1/20236/2/20237/1/2023Completed2/12/2024N/A
DME Fee Schedule O&P Codes5/26/20236/1/2023Completed6/7/2023N/A
Community Care Program In-Home Service Rate Increase - Effective 4/1/20235/1/20234/1/2023Completed3/16/2023N/A
Rate Correction Letter for West Suburban4/27/2023VariesCompleted5/8/2023Completed
Updated LPHA (Licensed Practitioners of the Healing Arts) Fee Schedule4/19/20234/1/2023Completed3/28/2023N/A
NF and SLP Rates 4/1/20234/6/20234/1/2023Completed4/7/2023N/A
Updated COVID-19 Fee Schedule4/6/2023VariesCompleted4/7/2023N/A
Coding Change for Depression Screenings - Effective 4/1/20233/28/20234/1/2023Completed3/29/2023N/A
Practitioner Fee Schedule - Effective 1/1/20233/15/20231/1/2023Completed3/29/2023Completed
SBHC Fee Schedule - Effective 1/1/20233/15/20231/1/2023Completed4/4/2023N/A
Podiatry Fee Schedule - Effective 1/1/20233/15/20231/1/2023Completed3/31/2023N/A
Updated COVID-19 Fee Schedule3/13/20231/1/2023Completed3/14/2023N/A
Revised RY 23 MPA MHVA Rates (Additional Update on 3/10/2023)3/6/202310/1/2022Completed3/28/2023Completed
Revised Rate Sheet for Montrose Behavioral Hospital for Children2/14/20231/1/2023Completed3/28/2023Completed
St. James Final MPA Rate After Late Appeal2/14/202310/1/2022Completed2/24/2023Completed
Coverage of Interprofessional Consultation Procedure Codes for Psychiatric Services - Effective 2/1/20232/3/20232/1/2023Completed2/23/2023N/A
Updated Practitioner Fee Schedule for 12/31/20221/12/202312/31/2022No Updates N/A
Medicaid Rate List for Nursing Facilities, County Nursing Facilities, and SMHRF's1/10/20231/1/2023Completed1/12/2023N/A
Supportive Living Program Rates - Effective 1/1/20231/10/20231/1/2023Completed1/17/2023N/A
COVID-19 Fee Schedule Update1/9/2023VariesCompleted1/12/2023Completed
Final RY 2023 MPA and MHVA Rates to Plans - 10/3/2022-9/30/20231/6/202310/1/2022Completed2/2/2023Completed
Community Care Program - In-Home Rate Increase - 1/1/202312/22/20221/1/2023Completed12/16/2022N/A
10/1 Rates for SNF and SLF - for Decatur Manor - Sharon Health Care Woods12/22/202210/1/2022Completed12/28/2022Completed
Update to Outpatient Rates for OSF St. Elizabeth - Ottata12/16/202210/1/2019Completed1/20/2023Completed
Correct Outpatient Rates for Javon Bea Hospital12/16/20227/1/2019Completed1/20/2023Completed
Updated C-19 Fee Schedule - Note on End Date of Bebtelovimab12/14/2022VariesCompleted12/29/2022N/A
Rate Increases for DRS and Aging - Effective 1/1/2023 (Homemaker)12/8/20221/1/2023Completed12/16/2022N/A
10/1 Practitioner Fee Schedule12/2/202210/1/2022Completed1/17/2023Completed
SMHRF Rate Updates12/1/2022VariesCompleted12/5/2022Completed
FQHC and RHC Rates for CY 2023 State Revision 12/5/202211/29/20221/1/2023Completed12/22/2022N/A
2023 Increases - Dental and Transportation11/18/20221/1/2023Completed12/15/2022N/A
Retroactive Rate Change for Methodist Medical Center, Peoria (Effective 1/1/2022)11/10/20221/1/2022Completed11/25/2022Completed
IDOA Enhanced Rate - Homemaker Providers Increase11/10/202211/1/2022Completed11/17/2022N/A
New Novavax Booster Effective 10/19/22 for Age 18+ (COVID-19 Fee Schedule)11/3/202210/19/2022Completed11/14/2022N/A
Updates Due to Capital Rate Exceptions - Grouped by Rate Quarter (Retro LTCF Rates)11/1/2022VariesCompleted11/17/2022Completed
Advanced Copy of Updated COVID-19 Fee Schedule 91314, 0144A, 91315, 0154A - Effective 10/12/202210/28/202210/12/2022Completed11/4/202Completed
Updated COVID-19 Fee Schedule10/24/2022VariesCompleted12/7/2022Completed
Quantity Limit for HCPCS A439310/7/20229/1/2022Completed11/8/2022N/A
Updated (CBS) Community-based Behavioral Health Services Fee Schedule - Effective 7/1/202210/6/20227/1/2022Completed7/13/2022N/A
New COVID-19 Booster Vaccinations9/30/2022VariesCompleted9/15/2022N/A
Hospice Annual Rate Changes - Effective 10/1/20229/22/202210/1/2022Completed9/27/2022N/A
RY 23 Initial MPA MHVA Rates9/19/2022VariesCompleted11/18/2022Completed
Revised OP Hospital Rate Sheet for Ingalls Memorial9/19/20227/1/2022Completed12/16/2022Completed
Updated COVID-19 Fee Schedule9/14/2022VariesCompleted9/15/2022N/A
MonkeyPox (MPV) - Advanced Notice of Testing Code/Rate9/2/20227/26/2022Completed9/15/2022N/A
Renal Dialysis Rates and Provider UPdates9/2/2022VariesCompleted10/25/2022Completed
Updated Practitioner Fee Schedule - Effective 7/1/2022 Updated 8/24/228/24/20227/1/2022Completed9/14/2022Completed
Updated Practitioner Fee Schedule Modifier - Effective 8/11/20228/11/20227/1/2022Completed4/27/2022N/A
SUPR Rate Sheet for MCO's Version - July Version8/3/20221/1/2022Completed8/8/2022N/A
Hospital Outpatient Claims for Sexual Assault Treatment Services per Public Act 102-06997/28/20227/1/2022Completed10/3/2022N/A
Podiatry Fee Schedule7/25/20224/1/2022Completed8/5/2022N/A
Updated COVID-19 Fee Schedule (Novavax Vaccine/Admin Code Addition)7/21/20227/13/2022Completed7/25/2022N/A
Optometry Fee Schedule Update 9/1/20227/18/20229/1/2022Completed7/19/2022N/A
New Rates for LTC7/13/20227/1/2022Completed7/20/2022N/A
Hospital Outpatient Claims with JW Modifier7/12/202211/18/2021Completed8/8/2022Completed
Supportive Living SLP Rate Update7/12/20227/1/2022Completed7/14/2022N/A
Changes in Billing Policy for Integrated Assessment and Treatment Planning (IATP), Community Support, and Crisis Stabilization Services7/1/20227/5/2022Completed7/8/2022N/A
SMHRF July 1 Rate Increase (Specialized Mental Health Rehabilitation Facilities)6/30/20227/1/2022Completed8/9/2022N/A
Updated 2021 Practitioner Fee Schedule - Effective 4/1/20226/30/20224/1/2022Completed8/3/2022Completed
OP High Volume Adjustment - Revised Rates - Effective 7/1/20226/30/20227/1/2022Completed8/22/2022Completed
Birth Center Rates - Effective 7/1/20226/29/20227/1/2022Completed7/13/2022N/A
Immunization Administration Rate Increase to $16.71 - Effective 7/1/20226/23/20227/1/2022Completed6/30/2022N/A
HB4700 CMHC Rate Increases on Specified Services - Effective 7/1/20226/15/20227/1/2022Completed6/23/2022N/A
New Modifier 93 and Place of Service 10 Have Been Added to Telehealth Benefits - Effective 7/1/20223/31/20227/1/2022Completed6/6/2022N/A
Modifier 93 and Place of Service Code 10 Implementation 4/1/20223/21/20227/1/2022Completed4/25/2022N/A