MedicaidDocumentationMedium impact
Medical Necessity for COVID-19 Testing and Confirmation of Ordering/Referring/Prescribing (ORP) National Provider Identifier (NPI) Requirements
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Sep 4, 2024
We identified it
Jun 20, 2026
Summary
Illinois Medicaid clarifies that COVID-19 testing must meet medical necessity requirements and reinforces that independent laboratories, pharmacies, and local health departments must include ordering/referring/prescribing (ORP) provider NPI numbers on all COVID-19 testing claims for both Medicaid FFS and managed care plans.
Action Required
Immediately: Independent laboratories, pharmacies, and local health departments must ensure all COVID-19 testing claims include the ordering/referring/prescribing provider NPI number in billing systems for both Medicaid FFS and MCO claims. Verify claim editing systems are configured to require ORP NPIs. Document medical necessity justification for all COVID-19 testing consistent with CDC recommendations.