MedicaidAdministrativeMedium impact
Referring Provider NPI Usage on Outpatient Claims
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Illinois Medicaid clarifies that Referring Provider NPI information should only be included on outpatient UB-04 and 837I claims when the referring provider differs from the attending provider. Starting October 1, 2019, claims with invalid or unenrolled referring provider NPIs will be rejected rather than just receiving informational messages.
Action Required
Before October 1, 2019: Billing team must update claim submission processes to only include Referring Provider NPI on UB-04 and 837I outpatient claims when referring provider differs from attending provider. Verify all referring providers are enrolled with Illinois Medicaid. Remove referring provider information from claims where it's not required to avoid rejections.