MedicaidAdministrativeHigh impact
Pharmacy Changes for Participants in the Managed Care Program
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Aug 1, 2005
We identified it
Jun 21, 2026
Summary
Effective August 1, 2005, pharmaceutical benefits are carved out of Illinois' managed care program. Pharmacies must now bill Healthcare and Family Services (HFS) directly using the recipient's RIN for all Medicaid, FamilyCare, and KidCare participants enrolled in MCOs, even though the MCO name still appears on patient cards.
Action Required
By August 1, 2005: Pharmacy staff must update billing procedures to submit all prescription claims for Medicaid MCO enrollees directly to HFS using the patient's Recipient Identification Number (RIN) instead of billing the MCO. Use NCPDP 5.1 eligibility inquiry or HFS online MEDI system to look up RIN if patient lacks their card. Failure to follow new billing process will result in claim processing delays.