MedicaidAdministrativeMedium impact
Hospital Enrollment as Pharmacy Provider Type to Bill Opioid Antagonist Dispensing Fee
Illinois Medicaid - HFS·IL · Emergency Medicine, Pharmacy·Provider Notice
Effective date
Jan 19, 2024
We identified it
Jun 20, 2026
Summary
Hospitals must now enroll as a separate pharmacy provider type through the IMPACT system to bill dispensing fees for opioid antagonist medications (like naloxone) given in emergency departments. This creates a new billing pathway separate from standard emergency department claims for these medications.
Action Required
Hospitals dispensing opioid antagonist medications in emergency departments must: 1) Enroll as a pharmacy provider type through the IMPACT system if not already enrolled, 2) Ensure proper contracting and authorization with MCOs before submitting claims, 3) Submit dispensing fee claims through Illinois Rx Portal PBMS for Medicaid FFS patients, 4) Submit dispensing fee claims to individual MCO PBMS systems for managed care patients. Contact pharmacy consultant at 877-782-5565 for FFS questions or appropriate MCO for managed care questions.