Illinois Rx Portal Pharmacy Benefits Management System (PBMS)
Any claims submitted after Go-Live will be rejected if you are still using the old BIN/PCN numbers.
View the updated Payor sheet for the details of additional information that needs to be changed when submitting NCPDP D.0 claim transactions. Pay particular attention to the Coordination of Benefits/Other Payments Segment Questions section of the payor sheet.
IMPORTANT DATES AND TIMES DURING THE TRANSITION:
REGISTRATIONS FOR THE ILLINOIS PROVIDER PORTAL
Watch your e-mail on March 22nd for registration information for the Illinois Provider Portal.
The Illinois Medicaid Pharmacy Point of Sale (POS) system will be unavailable beginning at 5:00 PM CDT Saturday, March 25th through 5:00 PM Sunday, March 26th.
Pharmacy claims will not be adjudicated during this time
Pharmacies should hold all claims during this time for submission after 5:00 PM CDT on Sunday, March 26th
PRIOR AUTHORIZATION REQUESTS:
Prior Authorization (PA) requests will not be accepted after 3:00 PM CDT on Friday, March 24th through:
- Prior Authorization/Refill Too Soon (PARTS) Hotline
- Four Script Prior Authorization Request Web Application
- Medical Electronic Data Interchange
The Department will reimburse pharmacies for medications dispensed during the blackout period when claims are submitted in the new PBMS. For medications dispensed during the blackout period requiring prior authorization, pharmacies should submit prior authorization requests once the new PBMS is implemented. The Department will approve prior authorization requests for medications dispensed for the prescribed day supply during the blackout period.
The PARTS Hotline will reopen beginning at 8:30 AM CDT on Monday, March 27th
HFS encourages providers to process prescriptions and refills needed by medical programs participants prior to the scheduled downtime to avoid any potential interruptions of care
INFORMATION ON MEDI
After March 24th, the Web Application MEDI will no longer be available for submitting prescription prior authorization requests. PA requests can be submitted through the new PBMS Provider Portal to submit prior authorization requests.