Date: October 31, 2019
To: All Medical Assistance Program Providers
Re: Ordering/Referring/Prescribing Provider – Delay to January 1, 2020
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 until January 1, 2020. This applies to claims for persons with traditional fee-for-service coverage as well as a HealthChoice Illinois managed care plan.
The last informational notice dated September 23, 2019 regarding ordering/referring/prescribing providers contains links to earlier policy releases.
Providers not enrolled must go to the IMPACT webpage to start the enrollment process. The Department has made available an Illinois Medicaid Provider Directory housed on the IMPACT home page. The directory may be used to verify enrollment of a provider in the Illinois Medical Assistance Program.
Questions regarding this notice may be directed to a billing consultant for the specific provider type at 877-782-5565.