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High Risk Providers
IMPACT Provider Enrollment Services has implemented provider requirements and provider screening processes to comply with the Affordable Care Act (ACA), such as risk level classifications assigned by provider type. The risk level classifications have been established by the Centers for Medicare & Medicaid Services (CMS) and IMPACT has adopted these same guidelines. In cases where provider types are not classified by CMS, IMPACT has established the risk level classification.
Risk Level Classifications
All Illinois Medicaid-enrolled providers are assigned one of the following three risk levels, based on provider type:
- Limited
- Moderate
- High
Note: A provider’s assigned risk level classification may be subject to change at any time.
Provider Types and Specialties
The provider type is how the provider is enrolled with Illinois Medicaid. Provider types are divided into subtypes, referred to as provider specialty. The specialty refers to services the provider is licensed or qualified to provide.
Screening Requirements Are Based on Risk Level Classifications
IMPACT performs a screening for each provider during enrollment and again at revalidation, corresponding the appropriate risk level classification. For example, moderate and high-risk providers are required to have onsite visits before and after enrollment to comply with the CMS final rule 42 CFR 455.432. High risk providers are required to submit fingerprints and undergo criminal background checks prior to enrollment.
If you are categorized as a high-risk provider, please follow the guidelines listed below to ensure your IMPACT enrollment is processed as quickly as possible:
Submit ALL required documentation via the Document Upload feature within the IMPACT system. All electronic documents must be in a PDF format.
New Provider Checklists
The Federal Centers for Medicare and Medicaid Services (CMS) categorizes Durable Medical Equipment, Prosthetics, Orthotics and Supply (DMEPOS) providers as high risk. To ensure Federal requirements are being met, the State of Illinois will be flowing the Federal requirements. To be eligible for enrollment with Illinois Medicaid as a DMEPOS providers, the following requirements must be met:
- Obtain and maintain a state license or be exempt from licensure.
- Be accredited by one of the listed national accreditation organizations recognized by CMS and the Department. Additional information for each organization can be found in the attached documentation. The list of organizations can be found here,
- Accreditation Commission for Health Care, Inc.
- American Board for Certification in Orthotics & Prosthetics, Inc.
- Board of Certification/Accreditation International
- Community Health Accreditation Program
- Healthcare Quality Association of Accreditation
- National Association of Boards of Pharmacy
- The Compliance Team, Inc.
- The Joint Commission
- Have an onsite visit completed prior to application approval or revalidation.
We have provided Provider Checklists (listed below) as a tool to ensure all documents have been gathered prior to submitting as a completed package to IMPACT Provider Enrollment Services for review.
New Provider Checklist – Transportation Providers
New Provider Checklist – Home Health Providers
New Provider Checklist – Durable Medical Equipment (DME) Providers