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Provider Notice Issued 06/16/2021

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

 

 

This bulletin 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. 

 

The 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

42 CFR 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.

 

 

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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director