View the Illinois Medicaid Provider Profile

The Medicaid Provider Profile page shows the Medicaid services provided by your facility, along with the values and effective dates of Medicaid reimbursement calculations.

To access the Medicaid Provider Profile page, select Go To > Government Payor Research > Medicaid > Provider Profile. The Medicaid Provider Profile page opens.
In the Select State or Payer drop down list, select IL.
Select Go.
Enter the provider’s tax ID or ten-digit National Provider Identification (NPI) number for the provider you want to review in the NPI or Provider Number field.
Enter a date in the Effective Date field if you want to view provider profile information for an effective date other than today.
Click Display Profile. The Medicaid Provider Profile information displays.
Note: To clear the results and return to original Medicaid Provider Profile page, click Reset.
Review your Medicaid Provider Profile information.

Note: The data that displays on the provider profile varies from state to state.

Illinois Medicaid Provider Profile

The following table describes each of the fields on the Medicaid Provider Profile page for Illinois Medicaid.

Field	Description
State or Payer	State or payer for the selected provider number.
NPI or Provider Number	Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims
Effective Date	Date on which the selected profile went into effect
Inpatient Hospital
Begin Date	Rates effective date.
End Date	Rates end date.
Hospital Type	Identifies the hospital type.
Legislative Reduction Factor	The amount reduced from the Total Expected Reimbursement for facilities that do not meet the criteria for designation as a Safety Net or Critical Access hospital.
Medicaid Base Rate (APR-DRG)	Base rate for inpatient services as determined by the Illinois administrative code.
General Per Diem Rate	State determined per diem rate for per diem paid hospitals.
Rehab Per Diem Rate	Rate per day used for rehab services.
Psych Per Diam Rate	Rate per day for hospital unit inpatient psychiatric services.
Trauma Center Level	Policy adjustors applicable for trauma DRGs at Level 1 and 2 Trauma hospitals with different factor amounts. Services without a policy adjustor have a factor of 1.0.
Perinatal Level	Policy adjustors applicable for neonate and maternity services at Perinatal Level III hospitals with different factor amounts. Services without a policy adjustor have a factor of 1.0.
DSH Add-on Rate	Disproportionate share rate for additional payments to qualifying hospitals for services vital to Medicaid customers.
MPA Add-on Rate	Reimbursement rate for Medicaid Percentage Adjustment (MPA) determinations.
MHVA Add-on Rate	Reimbursement rate for Medicaid High Volume Adjustment (MHVA) determinations.
Children’s DSH Add-on Rate	Disproportionate share rate for additional payments to qualifying hospitals for services vital to Medicaid customers for children's hospitals.
Children’s MPA Add-on Rate	Reimbursement rate for Medicaid Percentage Adjustment (MPA) determinations for children’s hospitals.
Children’s MHVA Add-on Rate	Reimbursement rate for Medicaid High Volume Adjustment (MHVA) determinations for children’s hospitals.
Safety Net Add-on Amount	A factor added for "Safety Net" or Critical Access hospitals to calculate the Total Expected Reimbursement. "Safety Net" or Critical Access hospitals are exempt from the SMART Act reduction.
Psychiatric Add-on Amount	A factor added for psychiatry services.
Crossover Adjustment	A factor added for crossover claims.
Cost-to-Charge Ratio	The ratio for determining hospital cost based on charges.
Wage Index	Percentage of the wage index to apply.
Labor Portion	Wage index labor portion percentage to apply to the facility specific adjusted base rate.
Medical Education Portion	Facility specific rate added to teaching hospitals.
Cost Outlier Threshold	High cost marginal threshold amount used in the determination of high cost outlier calculations.
SOI 1 SOI 2 Marginal Cost Factor	The Marginal Ratio used in the cost outlier calculation for SOI 1 and 2. For SOI 1 or 2, the marginal ratio is 0.8000.
SOI 3 SOI 4 Marginal Cost	The Marginal Ratio used in the cost outlier calculation for SOI 3 and 4. For SOI 3 or 4, the marginal ratio is 0.9500.
Rate Enhancement	Indicates that a facility receives rate enhancements.
Outpatient Hospital
Begin Date	Rates effective date.
End Date	Rates end date.
Grouper Type	The type of grouper used for this profile.
Grouper Version	The DRG grouper version used for this profile.
Medicaid Base Rate (EAPGS)	Facility specific EAPG conversion factor base rate
Rehab Base Rate	Facility specific rehab conversion factor base rate.
Eligible for High Cost Drug/Device Add-on	Identifies if the OP provider is eligible for high cost drug/device add-on amount.
SMART Act Reduction Facility	Identifies if the OP provider is exempt from the SMART Act reduction: "Safety Net" or Critical Access hospitals are exempt from the SMART Act reduction. Acute, Rehab, or Psych facilities are subject to the SMART Act reduction.