MedicaidAdministrativeHigh impact
Revision of the DPA 1443, Provider Invoice
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2006
We identified it
Jun 21, 2026
Summary
Illinois Healthcare and Family Services revised the DPA 1443 Provider Invoice form to comply with HIPAA requirements. Providers can begin using the new form DPA 1443 (R-4-04) immediately, but must transition completely by January 1, 2006, as the old form (R-1-91) will be rejected after that date.
Action Required
By January 1, 2006: Billing team must transition to using only the revised DPA 1443 (R-4-04) Provider Invoice form for all Illinois Medicaid claims. Download the new form and billing instructions from the HFS website at hfs.illinois.gov/handbooks/. Update billing workflows and staff training. Claims submitted on the old DPA 1443 (R-1-91) form after January 1, 2006 will be returned to the provider.