MedicaidAdministrativeHigh impact
Resumption of NPI Editing for Ordering/Referring/Prescribing Providers
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Aug 1, 2020
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is resuming NPI validation editing for ordering/referring/prescribing providers effective August 1, 2020. All providers who order, refer, or prescribe services for Medicaid patients must have valid NPIs and be enrolled with Illinois Medicaid, or claims will be rejected.
Action Required
By August 1, 2020: Billing team must verify all ordering/referring/prescribing providers have valid NPIs and are enrolled with Illinois Medicaid. Update provider database to include enrollment status. Ensure all claims include valid ORP provider NPIs before submission. Claims with invalid or unenrolled ORP provider NPIs will be denied.