MedicaidAdministrativeMedium impact
Chapter P-200, Handbook for Providers of Pharmacy Services Recipient Restriction Program
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Aug 20, 2014
We identified it
Jun 20, 2026
Summary
For Medicaid recipients restricted to a specific clinic, pharmacies must now identify the prescribing physician in field 411-DB and the restricted clinic's NPI as the primary care provider in field 421-DL when billing for medications.
Action Required
Immediately: Billing team must update pharmacy billing procedures for Medicaid Recipient Restriction Program participants restricted to clinics. Enter prescribing physician in Prescriber ID field (411-DB) and restricted clinic NPI in Primary Care Provider ID field (421-DL). Update billing software templates and train staff on new field requirements. Contact RRP hotline at 1-800-325-8823 for participant status questions.