Date: June 16, 2021
To: Advanced Practice Nurses and Physicians
Re: Chapter A-200, Handbook for Practitioners
Rendering Medical Services
Claim Submission Policy Update for
Services Rendered by Advanced Practice Nurses Effective with Dates of Service
on and after September 1, 2021
clarifies billing requirements for services rendered by Advanced Practice
Nurses. This billing policy applies to services submitted under the Medicaid
fee-for-service program, a HealthChoice
Illinois managed care plan (including YouthCare), or the Medicare-Medicaid
Alignment Initiative program.
Department had historically allowed the services of an APN to be billed under
the collaborating physician’s name and NPI, as permitted under the Code of
Federal Regulations at
441.22(c). However, later guidance under 42 CFR 455.410 contains
provider screening and enrollment requirements prompted by the Affordable Care Act
that state all professionals providing services under the State Plan or under a
waiver of the Plan be enrolled as participating providers.
Effective with dates of service beginning September 1, 2021, claims
must identify the APN as the rendering or ordering/referring/prescribing
provider as applicable with the APN’s name and NPI. Services may not be billed
under the collaborating physician’s name and NPI.
APNs providing services must be enrolled as a
Rendering/Servicing provider in IMPACT. APNs not already enrolled should follow the
steps on the IMPACT webpage.
The Handbook for Practitioners Rendering Medical Services has been updated to
reflect the new policy. Questions regarding this bulletin may be directed to
the Department’s Bureau of Professional and Ancillary Services at 877-782-5565,
or to the applicable managed care plan.