Attending Provider NPI Requirements Delay to November 1, 2019
September 24, 2019
MEMORANDUM
Attending Provider NPI Requirements Delay to November 1, 2019
Ordering/Referring/Prescribing Provider Enrollment and Provider Directory
On Monday, the Department of Healthcare and Family Services (HFS) released two notices: 1) Attending Provider NPI Requirements Delay to November 1, 2019; and 2) Ordering/Referring/Prescribing Provider Enrollment and Provider Directory. HFS is delaying implementation of requirements for both issues by one month, from October 1, 2019 to November 1, 2019.
Attending Provider NPI Requirements Delay to November 1, 2019
Effective with dates of service on and after November 1, 2019, the Department will reject claims if the Attending Provider is not an individual or is not enrolled. Click here for the notice.
Ordering/Referring/Prescribing Provider Enrollment and Provider Directory
Effective with dates of service on and after November 1, 2019, claims that contain an ordering/referring/prescribing provider who is not enrolled with the Department will be denied. Click here for the notice.
In an effort to assist providers in verifying enrolled ordering/referring/prescribing Medicaid providers in the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) system, the Department has made available an Illinois Medicaid Provider Directory on the IMPACT home page.
There are options to review a complete Provider List and to search by an NPI, Provider Type, Specialty or Sub-specialty. If no results are returned, then either the provider is not enrolled, or the enrollment has been end-dated. The Provider Directory will be updated weekly.
Even though HFS has delayed the implementation of the IMPACT enrollment verification edit until November 1, 2019, hospitals are highly encouraged to immediately begin using the available Provider Directory lookup feature, prior to submitting a claim for payment to verify the enrollment status of Ordering, Referring or Prescribing medical professionals reported on the claim. The enrollment requirement is a federal compliance issue for the Illinois Medicaid program, and further implementation delays are unlikely.