Date: June 25, 2019
To: All Medical Assistance Program Providers
Re: Ordering, Referring, Prescribing - National Provider Identifier (NPI) Requirements - Delay in Implementation to October 1, 2019
This notice informs providers of a delay in requiring ordering/referring/prescribing practitioners to be enrolled in the Illinois Medical Assistance Program. The new implementation date in this notice applies to Medicaid fee-for-service claims as well as HealthChoice Illinois managed care claims.
Per Informational Notices dated November 9, 2018 and December 28, 2018, the Department notified providers of its intent to require ordering/referring/prescribing practitioners to be enrolled. The implementation date for this requirement has been delayed to October 1, 2019.
Effective with dates of service on and after October 1, 2019 (excluding pharmacy claims, see below), the Department will reject claims if the required ORP information is missing or invalid, or if the ORP is not enrolled with the Department.
Effective with claim receipt dates beginning October 1, 2019, the Department will reject pharmacy claims submitted through the pharmacy point-of-sale system if the prescribing practitioner identified on the pharmacy claim is not enrolled with the Department.
For dates of service prior to October 1, 2019, the Department will send informational messages to providers if the required ORP claim information is missing or invalid, or if the ORP is not enrolled with the Department.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.