MedicaidAdministrativeMedium impact
Delay in Implementation of the Edits Regarding the Reporting of the Prescriber’s National Provider Identifier (NPI)
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Aug 6, 2008
We identified it
Jun 21, 2026
Summary
Illinois Medicaid has delayed implementing edits that would reject pharmacy claims without prescriber NPIs. Pharmacies must continue working toward 100% NPI compliance but can still use DEA numbers or state license numbers as exceptions when NPIs cannot be obtained after diligent effort.
Action Required
Ongoing: Pharmacy billing staff must continue diligent efforts to obtain prescriber NPIs for all claims submitted to Illinois Medicaid. Search the NPPES NPI registry for missing NPIs. Only use DEA numbers, state license numbers, or legacy provider numbers when NPIs cannot be obtained after exhaustive efforts. For Recipient Restriction Program clients, populate Primary Care Provider ID field (421-DL) with the provider's NPI when required.