MedicaidAdministrativeHigh impact
National Provider Identifier (NPI) – Implementation for Pharmacies
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Jan 2, 2008
We identified it
Jun 21, 2026
Summary
Effective January 2, 2008, all Illinois pharmacies must include their National Provider Identifier (NPI) in the Service Provider ID field when billing Medicaid, or claims will be rejected. Electronic reversals, prior approvals, and eligibility transactions must also contain the NPI.
Action Required
By January 2, 2008: Pharmacies must update billing systems to include their NPI in the Service Provider ID (201-B1) field with qualifier 01 for all Medicaid claims. Update all electronic NCPDP 5.1 transactions (reversals, prior approvals, eligibility) to include NPI. Report NPI to Illinois Department of Healthcare and Family Services immediately if not already done. Claims without NPI will be rejected after this date.