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New Medicaid Requirements Take Effect October 1 for Healthcare Professionals Who Order, Refer or Prescribe
Posted on: 7/15/2019

Heads up: All Medicaid claims for services provided on or after Oct. 1, 2019, that require an ordering or referring healthcare professional must include the name and National Provider Identifier (NPI) of the professional who ordered or referred the services.

The Illinois Department of Healthcare and Family Services (HFS) will reject claims if the health professional’s name and NPI are not on the claim, or if the claim contains information for a physician or health professional who is not enrolled through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system. Additionally, the health professional will not receive reimbursement for those services.

Also effective October 1, HFS will reject pharmacy claims submitted through the pharmacy point-of-sale system if the prescriber identified on the pharmacy claim is not enrolled through IMPACT.

These new requirements will apply to Medicaid fee-for-service claims, as well as HealthChoice Illinois managed care claims and claims in which the primary payer is Medicare.

HFS has delayed the original deadline for these requirements to the new date of October 1.

For more information, access HFS’ June 25, 2019, Provider Notice. If you have questions, please contact HFS by calling 877-782-5565.

You may also contact the ISMS advocacy team by calling 800-782-4767, ext. 1470, or by sending an email.

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