Illinois Medicaid Provider Enrollment - Frequently Asked Questions
Who needs to enroll in Illinois Medicaid?
Beginning January 1, 2020, any provider who performs services on or prescribes for a participant in the Illinois Department of Healthcare and Family Services’ (HFS) Medical Programs must be enrolled and identified by a National Provider Identifier (NPI) registered with the HFS IMPACT system in order to submit a claim for reimbursement. This requirement applies to claims for persons with traditional Medicaid fee-for-service coverage, any HealthChoice Illinois managed care plan, and any IL MMAI (Medicaid-Medicare Alignment Initiative) plan where a service is covered all or in part by Medicaid. Per the Patient Protection and Affordable Care Act section 6401(b) and subsequent federal regulations at 42 CFR 455.410(b) and 455.440, HFS is mandated to require this registration and is subject to federal audit.
How do I enroll?
IMPACT and the enrollment process is available at hfs.illinois.gov/impact/aboutimpact
Prior to being able to complete the enrollment, anyone who needs access to the IMPACT system will need to create a user ID and password through a single sign-on process. This process can be done anytime. To begin, go to impact.illinois.gov and click on Create New Account.
What information do I need?
National Provider Identifier (NPI) Number – The federal government requires providers who administer “medical and other health services” obtain an NPI number – a unique 10-digit identification number for covered healthcare providers. For more information, visit the federal CMS HIPAA webpage.
Ensure a Certified W9 is On File – Any provider who will be receiving state/federal funds directly from the Comptroller for services rendered or provided to Medicaid clients must have a certified W9 tax form on file with the State Comptroller.
Renew any Professional Certifications or Licensures – Providers must maintain current certification or licensure as a condition of participation in the Medicaid Program. If your profession requires a certification or licensure in the State of Illinois, these qualifications must be active at the time of enrollment or revalidation. This includes the Clinical Lab Improvement Amendments Certification, administered by the Illinois Department of Public Health Office of Health Care Regulation.
Ensure the Appropriate Web Access – IMPACT requires each provider to submit an active email address. Email will become the primary mode of communication between contract agencies and providers, and an email address is a required field for enrolling or revalidating in the IMPACT system. Additionally, to access the IMPACT provider portal, you must use an internet browser that is equivalent to Internet Explorer 8 – or a more recent browser.
Application ID Number – All providers that are currently enrolled will need to have a state-assigned application ID number on-hand to access their application in IMPACT to revalidate. These application ID numbers will be distributed two times via postal mail. Each currently enrolled provider should be on the lookout for an IMPACT mailing on yellow paper and should give this paper to the staff person that will complete the revalidation process. The IMPACT help desk will have the ability to look up application ID numbers for providers who may have misplaced or not received the postal mailing.
How do we request an effective date prior to the current date?
You will be able to specify a retroactive start date for your enrollment during the application process in the checklist portion of the application.
Do you need to register each NPI?
If the tax identification number (TIN) is the same, there are two options. You may have one enrollment including one TIN/FEIN, one NPI, a primary practice location while listing each additional location as other servicing locations. Alternatively, you may enter each NPI as a separate enrollment.
I am an out-of-state provider and having difficulty completing the License/Certification/Other step as it will not accept my license number.
If you are out of state, you will select the license type and enter, “out of state” in the space provided for the license number.
Who should I contact with further questions?
Please contact the Provider Participation Unit/Provider Enrollment Services at 877-782-5565. For questions concerning why Envolve requires providers to take this action, please contact Envolve Customer Service at 833-522-0132.