To: All Medical Assistance Program Providers
Re: Ordering/Referring/Prescribing Provider Enrollment and Provider Directory
This notice is a reminder that any provider who orders, refers, or prescribes for a participant under the Illinois Department of Healthcare and Family Services’ Medical Programs must be enrolled and identified by a National Provider Identifier (NPI) on applicable claims submitted. Per the Patient Protection and Affordable Care Act section 6401(b) and subsequent federal regulations at 42 CFR 455.410(b) and 455.440, the Department is mandated to require this and is subject to federal audit.
The Department is delaying implementation of the ordering/referring/prescribing requirements one month, from October 1, 2019, to November 1, 2019. Effective with dates of service on and after November 1, 2019, claims that contain an ordering/referring/prescribing provider who is not enrolled with the Department will be denied.
This policy applies to claims for persons with traditional fee-for-service coverage as well as a HealthChoice Illinois managed care plan. The Department has previously released the following notices on this topic:
Notice dated 11/9/18 - Ordering, Referring, Prescribing - National Provider Identifier (NPI) Requirements
Notice dated 12/28/18 - Ordering, Referring, Prescribing - National Provider Identifier (NPI) Requirements - Delay in Implementation
Notice dated 05/22/19 - Prescriber National Provider Identifier (NPI) Requirements Effective July 1, 2019
Notice dated 06/25/19 - Ordering, Referring, Prescribing - National Provider Identifier (NPI) Requirements - Delay in Implementation to October 1, 2019
Notice dated 07/18/19 - Correction - Hospital Outpatient Claims Referring Provider Requirements for October 1, 2019
In an effort to assist providers in verifying enrolled ordering/referring/prescribing Medicaid providers in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system, the Department has made available an Illinois Medicaid Provider Directory housed on the IMPACT home page.
There are options to review a complete Provider List and to search by an NPI, Provider Type, Specialty or Sub-specialty. If no results are returned, then either the provider is not enrolled, or the enrollment has been end-dated. The Provider Directory will be updated weekly.
Questions regarding this notice may be directed to a billing consultant for the specific provider type at 877-782-5565.