HFSIMPACTHigh Risk Providers

High Risk Providers

 




  
IMPACT Provider Enrollment Services has implemented provider requirements and provider screening processes to comply with the Affordable Care Act (ACA), such as risk level classifications assigned by provider type.  The risk level classifications have been established by the Centers for Medicare & Medicaid Services (CMS) and IMPACT has adopted these same guidelines.  In cases where provider types are not classified by CMS, IMPACT has established the risk level classification. 
Risk Level Classifications
All Illinois Medicaid-enrolled providers are assigned one of the following three risk levels, based on provider type:
·         Limited
·         Moderate
·         High
Note:  A provider’s assigned risk level classification may be subject to change at any time.
Provider Types and Specialties
The provider type is how the provider is enrolled with Illinois Medicaid.  Provider types are divided into subtypes, referred to as provider specialty.  The specialty refers to services the provider is licensed or qualified to provide. 
Screening Requirements Are Based on Risk Level Classifications
IMPACT performs a screening for each provider during enrollment and again at revalidation, corresponding the appropriate risk level classification.  For example, moderate and high-risk providers are required to have onsite visits before and after enrollment to comply with the CMS final rule 42 CFR 455.432.  High risk providers are required to submit fingerprints and undergo criminal background checks prior to enrollment.   
If you are categorized as a high-risk provider, please follow the guidelines listed below to ensure your IMPACT enrollment is processed as quickly as possible:
Submit ALL required documentation in one complete package to IMPACT.PESDOCS@illinois.gov *(this email is ONLY for submitting required documentation to the Department.  Do NOT reply or send ANY inquiries to this email address, as they will not be answered).  All electronic documents must be in one of the following formats:  PDF, JPG, DOC, or DOCX.  In the subject line of your email, you must include your IMPACT Application Identification number and your official provider name.
To send your information securely, the Department strongly recommends password protecting and using the following link to file transfer utility, https://filet.illinois.gov/filet/PIMupload.asp and send your password in a separate email.
New Provider Checklists
We have provided Provider Checklists (listed below) as a tool to ensure all documents have been gathered prior to submitting as a completed package to IMPACT Provider Enrollment Services for review.
New Provider Checklist – Transportation Providers
New Provider Checklist – Home Health Providers

IMPACT

 

 Need Assistance?