Nov. 7, 2025
For providers who submit claims for our members with Blue Cross Community Health PlansSM, following are reminders of the hospital 30-day readmission review process and steps to follow if you need to submit a dispute.
Hospital 30-day readmission rules: We review all subsequent hospital admission claims within the specified time frame governed by Illinois law, the applicable regulations and requirements set forth in Illinois Medicaid contracts.
- This process assesses all subsequent hospital admissions that occurred within 30 days of the previous discharge date.
- It determines whether each individual subsequent hospital admission is to be classified as a readmission for the same facility or hospital system.
- If we receive a claim for a subsequent hospital admission and determine the claim is a readmission, we’ll deny the claim unless exception criteria are met. See the review process for details.
Dispute process for readmission denials: If you’d like to dispute a decision, refer to the steps in our Medicaid provider dispute process overview. For readmission denials medical records for both hospitalizations are required for the review to be conducted.
For more information: Refer to the Medicaid hospital 30-day readmission review process.