MedicaidAdministrativeHigh impact
January 1, 2020 Requirements for Ordering/Referring/Prescribing Provider Enrollment and Managed Care Plan Adoption of HFS Preferred Drug List
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Starting January 1, 2020, all providers who order, refer, or prescribe services for Illinois Medicaid patients must be enrolled with a National Provider Identifier (NPI) on claims. Additionally, all managed care organizations must adopt the state's Preferred Drug List with aligned coverage requirements.
Action Required
By January 1, 2020: Verify all ordering, referring, and prescribing providers are enrolled in Illinois Medicaid program and have valid NPIs. Billing team must ensure all claims include enrolled provider NPIs or claims will be subject to federal audit issues. Use Illinois Medicaid Provider Directory on IMPACT homepage to verify enrollment status. Unenrolled providers must complete enrollment process through IMPACT webpage immediately.