MedicaidAdministrativeMedium impact
Correction - Hospital Outpatient Claims Referring Provider Requirements for
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Oct 1, 2019
We identified it
Jun 20, 2026
Summary
Illinois Medicaid corrected previous guidance about referring provider requirements for hospital outpatient claims. Provider Type Qualifier Code DN with Referring Provider NPI is only required when the Referring Provider NPI differs from the Attending Provider NPI, not on all outpatient claims as previously stated.
Action Required
By October 1, 2019: Billing team must update hospital outpatient claim submission to only include Provider Type Qualifier Code DN with Referring Provider NPI when the Referring Provider NPI differs from the Attending Provider NPI. Ensure all referring providers are enrolled with Illinois Medicaid Department or claims will be rejected. Emergency Room claims with Revenue Codes 0450, 0451, or 0456 are exempt from this requirement.