MedicaidAdministrativeHigh impact
Participating Optometrists, Optical Companies, and Physicians
Illinois Medicaid - HFS·IL · Optometry·Provider Notice
Effective date
Oct 1, 2005
We identified it
Jun 21, 2026
Summary
Illinois Healthcare and Family Services has revised the DPA 1443 Provider Invoice claim form to comply with HIPAA requirements. Providers can begin using the new form October 1, 2005, but must switch completely by January 1, 2006, as old forms will be rejected after that date.
Action Required
By January 1, 2006: Billing team must transition to the new DPA 1443 (R-4-04) claim form for all Illinois Medicaid submissions. Download the revised form and billing instructions from the HFS website at hfs.illinois.gov/handbooks/. Update billing workflows and staff training. All claims submitted on the old DPA 1443 (R-1-91) form after January 1, 2006 will be returned unpaid.