MedicaidAdministrativeHigh impact
Ordering, Referring, Prescribing - National Provider Identifier (NPI) Requirements
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
Illinois Medicaid is delaying implementation of NPI requirements for ordering/referring practitioners from January 1, 2019 to July 1, 2019. Starting July 1, 2019, all Medicaid claims requiring an ordering or referring practitioner must include the practitioner's name and NPI, and the practitioner must be enrolled in Illinois Medicaid, or claims will be rejected.
Action Required
Before July 1, 2019: Billing team must ensure all ordering/referring practitioners are enrolled in Illinois Medicaid through the IMPACT system. Update billing system to capture and validate NPI for all ordering/referring practitioners on Medicaid claims. Verify all ORP information is complete and accurate before claim submission. Claims will be rejected if ORP information is missing, invalid, or if the practitioner is not enrolled.