MedicaidAdministrativeHigh impact
Attending Provider NPI Requirements for October 1, 2019
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Starting October 1, 2019, Illinois Medicaid will reject institutional claims (UB-04/837I) if the Attending Provider NPI is not enrolled with the Department or is not an individual provider. Claims will receive rejection messages I52 and I53 for these errors, whereas previously they were only informational warnings.
Action Required
Before October 1, 2019: Billing team must verify all Attending Provider NPIs on institutional claims are enrolled with Illinois Medicaid and belong to individual providers (not organizations). Update claim review process to validate NPI enrollment status before submission. Contact unenrolled providers to complete enrollment via IMPACT webpage. Claims submitted after October 1st with invalid Attending Provider NPIs will be rejected.