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Take Action This Week to Ensure Medicaid UPL Reimbursements

To ensure hospitals continue to receive Hospital Participation payments (also known as Upper Payment Limit or UPL), please complete and return all the items listed below.

Please send the following items to by noon Friday, September 5.

Thank you for taking this important step as part of combined efforts with Health Alliance Connect, the Illinois Hospital Association and the Illinois Department of Healthcare and Family Services.

If you have still questions after reviewing the following Q&A, please call your provider relations specialist or 1-800-851-3379 ext. 4668.

What is Upper Payment Limit or UPL?

Federal rules impose an Upper Payment Limit or UPL—calculated every October for the following year—based on what Medicare would pay for the same patients, but applied to Medicaid.

How is UPL applied today?

Today it applies only to payments paid directly to hospitals by the state Medicaid Program—including fee-for-service or FFS (claims-based) + static payments—not payments by Managed Care Organizations (MCOs).

Why does the state need to have MCOs make hospital participation payments to hospitals?

UPL is decreased as hospital payments shift to MCOs, e.g. if FFS payments drop by 50 percent, UPL will drop correspondingly, thus the need for this change.


Provider Directory and HCBS Resources

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Provider Manual

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Resource List Coming Soon

View the Resources list for access to Home and Community Based Services resources

Preauthorization Requirements

Preauthorization List

View the preauthorization requirements for a complete listing of procedures and equipment that require preauthorization

Preferred Medications


Medicaid Formulary

View the Medicaid Formulary to find Preferred Medications.

Specialty Drug List
Mail-order Medications
Over-the-counter Medications


Medicare-Medicaid Formulary

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Over-the-counter Medications

Cultural Competency Training

Cultural Competency Training Coming Soon

View the Cultural Competency Training Manual and equip yourself with the tools needed to be effective with a diverse patient community.

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Contact Health Alliance Connect Client Services at 1-877-933-8480 with any questions about claims, appeals, contracts and more. More ways to contact us...

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