MedicaidAdministrativeMedium impact
Category of Risk of the Vendor
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Mar 7, 2013
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has established risk-based conditional enrollment periods for new providers, with high-risk vendors (including DME suppliers, home health, and transportation) subject to 1-year conditional enrollment and enhanced screening including criminal background checks and fingerprinting. The policy defines three risk categories with different oversight requirements and allows risk level adjustments based on Medicare certification or sanctions history.
Action Required
For practices enrolling in Illinois Medicaid: Review your vendor risk category classification and prepare for enhanced screening requirements during conditional enrollment period. High and moderate risk vendors must undergo criminal background checks, financial screening, and potential unannounced site visits. Ensure compliance with all licensing and certification requirements to potentially qualify for risk level reduction.