MedicaidAdministrativeMedium impact
Ordering/Referring/Prescribing Provider – Delay to January 1, 2020
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has delayed the requirement for ordering/referring/prescribing providers to be enrolled and identified by NPI on claims until January 1, 2020. This requirement applies to both traditional fee-for-service Medicaid and HealthChoice Illinois managed care plans.
Action Required
By January 1, 2020: Billing team must ensure all ordering, referring, and prescribing providers are enrolled in Illinois Medicaid and have valid NPIs included on all Illinois Medicaid claims. Verify provider enrollment using the Illinois Medicaid Provider Directory on the IMPACT home page. Unenrolled providers must complete enrollment at the IMPACT webpage. Claims without enrolled provider NPIs will be subject to federal audit requirements and potential issues.