MedicaidAdministrativeMedium impact
Pharmacy Claim Submissions with Incorrect Prescribing Provider Information
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Dec 28, 2016
We identified it
Jun 20, 2026
Summary
Pharmacies must ensure accurate prescribing provider NPI numbers are submitted on all pharmacy claims to prevent payment delays and claim rejections. The Illinois Department of Healthcare and Family Services is emphasizing pharmacist responsibility for verifying correct prescriber information before claim submission.
Action Required
Immediately: Pharmacy staff must verify and confirm the correct 10-digit National Provider Identifier (NPI) for all prescribing providers before submitting claims to Illinois Medicaid. Implement verification procedures to ensure actual prescriber NPI matches claim submission. Contact Bureau of Professional and Ancillary Services Pharmacy Billing Consultant at 877-782-5565 for questions.