Avoid Medicaid Claim Denials – Take Note of New Requirements for Healthcare Professionals Who Order, Refer or Prescribe
All Medicaid claims
for services provided on or after Jan. 1, 2020, 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 January
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 at least twice concerning these requirements.
For more information,
access HFS’ Oct.
31, 2019, Provider Notice, which includes a
link to the IMPACT Look-Up tool that can be used to verify if one is enrolled
in IMPACT. 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.