Date: July 8, 2020
To: All Medical Assistance Program Providers
Re: Resumption of NPI Editing for Ordering/Referring/Prescribing Providers
This notice informs providers that the Department will resume editing to ensure that ordering/referring/prescribing (ORP) provider National Provider Identifiers (NPIs) are valid and the providers are enrolled with the Department. This will be effective with claims received starting August 1, 2020, regardless of service date, and applies to claims for both managed care and traditional fee-for-service participants.
As a result of the current COVID-19 public health emergency, the Department had requested a waiver through the federal Centers for Medicare & Medicaid Services (CMS) to temporarily cease the requirement that providers who order, refer, or prescribe to Medicaid beneficiaries be enrolled with Illinois Medicaid. This waiver request was ultimately not approved by CMS. Therefore, the Department is resuming normal editing effective with claims received starting August 1, 2020.
Previous provider notices regarding ordering/referring/prescribing requirements are all available on the provider notices section of the Department’s website.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for participants covered under traditional fee-for-service, or to the applicable managed care plan.
Interim Medicaid Administrator