HFSIMPACTProvider Enrollment

Provider Enrollment

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Starting in 2015, Illinois will begin enrolling and revalidating all Medicaid-funded providers and billing agents through a new web portal to satisfy federal requirements in the Affordable Care Act, and to ensure that Illinois only works with legally compliant providers.

Before the IMPACT system comes online, the State will stop accepting provider applications and updates for a period of time.  

After the launch of the IMPACT system, paper enrollment applications or updates will no longer be accepted, and email will become the primary method for provider communication. 

While billing/claiming processes will remain unchanged in 2015 and 2016, failure to enroll or revalidate on time can lead to payment delays.

Please read the information below, and contact IMPACT.help@illinois.gov with any questions.

Defining Go-Live and Grand Opening

  • Go-Live – Go-Live refers to the date that the IMPACT provider portal comes online for the first time.  On the day of Go-Live, a “log on” button will appear on the home page of this website. The Go-Live date is primarily intended for billing services and clearinghouses (referred to as “billing agents” in the IMPACT system), who need to enroll between Go-Live and the Grand Opening.  Excluding billing agents and state staff, most providers can disregard the Go-Live date. 
  • Grand Opening  The Grand Opening refers to the date that providers who are currently enrolled will begin revalidating, as well as the date that new providers may begin their initial enrollment through the IMPACT system.  Illinois’ outreach efforts will focus on publicizing the Grand Opening, as the majority of providers entering the IMPACT system in 2015 will begin enrolling or revalidating after the Grand Opening.

Enrollment & Revalidation Phases

Enrollment and revalidation will occur in phases.  Additionally, enrollment must occur in a particular order so that associations may occur between billing agents, entities and individual providers.  You are encouraged to 1) review the Provider Enrollment Timeline for a high-level overview of the enrollment phases, and 2) check the Glossary to clarify which enrollment phase applies to your provider type before reading the narrative below.

Phase 1

Billing Agents Enroll (Two week period before the Grand Opening) - Billing services and clearinghouses (referred to as “billing agents” in the IMPACT system) will need to enroll within the first two weeks of the web portal coming online. Special outreach will be conducted to help billing agents enroll as soon as the IMPACT system comes online.

Phase 2

Revalidation of all currently enrolled Medicaid providers (6-month period after the Grand Opening) - The types of providers that are currently enrolled in the legacy MMIS will need to revalidate their information before the end of 2015. This applies to entities and individuals such as physicians, dentists, hospitals, pharmacies, FQHCs, nursing homes and ambulance service.  Revalidation should occur in a particular sequence:
  • Facilities, Agencies and Organizations (FAOs) Revalidate First - FAOs are encouraged to revalidate their information as soon as possible after the IMPACT Grand Opening. Individuals may need to associate with these entities, and this may only occur after the entities have revalidated their information in the IMPACT system. Slow participation by FAOs may delay or prevent the timely revalidation of affiliated individual providers.
  • Individuals (Sole Proprietors and Rendering/Servicing) Revalidate Second – Sole proprietors and rendering/servicing providers  (referred to as types of “individuals” in the IMPACT system) will be able to revalidate their information any time after the Grand Opening; however, the association of an individual with an affiliated FAO or group may only be completed after these entities have revalidated their information in IMPACT.  Slow participation by FAOs or groups may delay or prevent the timely revalidation of affiliated individuals. 
  • ***Tip for Clerical or Administrative Staff – It is possible to complete the revalidation process for an FAO or group at the same time as you revalidate an individual; however, you must still complete the revalidation in the proper sequence to allow associations between business affiliates to occur.

Initial Enrollment for New Providers (Ongoing after the Grand Opening) - New providers seeking to begin serving Medicaid clients for the first time will be required to enroll through the new IMPACT web-based provider portal. Paper enrollment applications or updates will no longer be accepted.  

  • This phase applies to individuals who just obtained licensure/certification, or practices that just began offering services to Medicaid clients. Groups will also need to complete an initial enrollment, and are encouraged to enroll as soon as possible after the Grand Opening.
  • This phase does not apply to the types of providers that serve Medicaid clients, but are not enrolled in the current MMIS (such as emergency medical technicians, drivers, dispatchers, homemakers, interns). The types of providers that are not enrolled in the current MMIS will continue using the existing processes until 2016. 

Phase 3

Initial Enrollment for Medicaid provider types not currently enrolled in MMIS (Beginning in 2016) – Waiver program providers that serve Medicaid clients, but are not currently enrolled in the legacy MMIS (referred to as “atypical agencies or individuals” in the IMPACT system), will need to enroll beginning in 2016. This applies to organizations and individuals such as emergency medical technicians, drivers, dispatchers, homemakers and interns. Providers that fall into this category will not experience any changes until 2016. More information will be provided through this website as the project moves forward.

Important Dates and Actions Before the Grand Opening

Before the IMPACT Provider Enrollment system comes online, there are several important deadlines and activities that providers and administrative staff must be prepared for.  These dates only apply to the types of providers that currently enroll in the legacy MMIS. Waiver program providers that enroll in systems other than with the current Medicaid system will continue using their existing processes and will not be affected by the activities listed below.

  • Cut Off for Provider Applications & Paper Updates (May 29, 2015) – Illinois will stop accepting new provider applications and paper-based updates approximately 60 days before the IMPACT system comes online. This deadline may change based on the volume of pending applications, and special accommodations may be made for urgent or high-priority issues; however, the State must suspend enrollments prior to the IMPACT system coming online in order to ensure that data is transferred from the current Provider Enrollment system to the IMPACT system. Providers are encouraged to adjust their internal processes as needed. Most providers will be able to request a retroactive enrollment effective date for consideration once the IMPACT system is live.
  • Cut Off for Electronic Updates (June 24, 2015) - Illinois will stop accepting electronic updates approximately one week before the IMPACT system comes online. This deadline may change based on the volume of pending updates, and special accommodations that may need to be made for urgent or high-priority issues; however, the State must suspend all changes to the legacy MMIS prior to the IMPACT system coming online in order to ensure that data is transferred from the current Provider Enrollment system to the IMPACT system. Providers are encouraged to adjust their internal processes as needed. Most providers will be able to request a retroactive enrollment effective date for consideration once the IMPACT system is live.
  • Application Identification Numbers Sent Via Postal Mail (May and July, 2015) – All providers that are currently enrolled will need to have a state-assigned application ID number on-hand in order to complete the revalidation process. These application ID numbers will be distributed two times via postal mail. Each currently enrolled provider should be on the lookout for an IMPACT mailing on yellow paper, and should give this paper to the staff person that will complete the revalidation process. The IMPACT help deskwill have the ability to look up application ID numbers for providers who may have misplaced or not received the postal mailing.

Getting Ready to Enroll: Prerequisite Steps for Providers

Many providers will need to take action before they are ready to enroll or revalidate their information in the IMPACT system.  To make sure your enrollment experience is as quick and efficient as possible, please investigate whether you need to complete any of these prerequisite steps before you attempt to enroll or revalidate.

  • Obtain a National Provider Identifier (NPI) Number The federal government requires that providers who administer “medical and other health services” should obtain an NPI number – a unique 10-digit identification number for covered health care providers. For more information visit the federal CMS HIPAA webpage.
  • Ensure a Certified W9 is On FileAny provider who will be receiving state/federal funds directly from the Comptroller for services rendered or provided to Medicaid clients must have a certified W9 tax form on file with the State Comptroller. 
  • Renew any Professional Certifications or Licensures – Providers must maintain current certification or licensure as a condition of participation in the Medicaid Program. If your profession requires a certification or licensure in the State of Illinois, these qualifications must be active at the time of enrollment or revalidation. This includes the Clinical Lab Improvement Amendments Certification, administered by the Illinois Department of Public Health Office of Health Care Regulation.
  • Ensure the Appropriate Web Access – IMPACT requires each provider to submit an active email address. Email will become the primary mode of communication between contract agencies and providers, and an email address is a required field for enrolling or revalidating in the IMPACT system. Additionally, in order to access the IMPACT provider portal you must use an internet browser that is equivalent to Internet Explorer 8 – or a more recent browser.
  • Obtain your Application ID Number - All providers that are currently enrolled will need to have a state-assigned application ID number on-hand in order to access their application in IMPACT so as to revalidate. These application ID numbers will be distributed two times via postal mail. Each currently enrolled provider should be on the lookout for an IMPACT mailing on yellow paper, and should give this paper to the staff person that will complete the revalidation process. The IMPACT help desk will have the ability to look up application ID numbers for providers who may have misplaced or not received the postal mailing.

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