Application Agent Request Process

Application Agents (AAs) are community-based providers and organizations that have ongoing contact with people likely to be eligible for medical, food, or cash assistance benefits under the State of Illinois Programs. The Department of Healthcare and Family Services (HFS) and the Department of Human Services (DHS) requires AAs to complete Agreements and participate in training that includes information on the different benefit programs available, how to complete an Application for Benefits Eligibility (ABE) Application, and the documentation required for program eligibility.

Third Party Billing/Medicaid Management organizations cannot hold Application Agent Agreements with the State but can work under a Provider or Organization that does have an Agreement with the State.

1. Complete and submit Request to become an HFS Application Agent 

Organizations that mainly assist with Medical Programs should submit the form to HFS.ApplicationAssisters@illinois.gov

Organizations providing developmental disability waiver and/or housing services should submit the form to DHS.BPN.ExternalUsers@illinois.gov

The DHS or HFS Application Agent Liaison will review the organization’s request to determine eligibility to become an Application Agent. The Liaison will then send out additional forms for completion:

2.  Application Agent Agreement

3.  Business Associate Agreement

4.  I-9 Form    

All Application Agent Applicant Organizations must enroll as a Provider through the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) System if not already enrolled. Instructions on this process will be shared by the HFS or DHS AA Liaison. You will be assigned a Provider ID to be used in ABE after completing the IMPACT enrollment process. Your agency must have a certified W9 tax form on file with the IL State Comptroller to enroll in IMPACT. Check requirements before starting the enrollment process. Go to http://IMPACTinfo.illinois.gov to enroll.

If you have any questions concerning IMPACT enrollment, contact the Help Desk at 1-888-618-8078 or by e-mail at IMPACT.help@illinois.gov.

HFS and/or DHS provide training materials for its partners and providers. Materials can be found on the  Application Agents page on the HFS website. There are also regularly scheduled live Webinars that will be posted to the AA site and/or shared with your agency administrator for registration. All AAs must attend a Webinar or complete an online training module prior to offering assistance services to customers.

Once all requirements are complete, an ABE indicator will be added to the organization’s IMPACT account and the Organization’s information will be transferred into the ABE Provider Portal. You will be notified via email when your enrollment is complete.

Your notification of AA enrollment will include your assigned provider number to be used when setting up Accounts in the ABE Provider Portal and instructions on how to create your ABE ILPartner Account. A 1706P ABE Provider Portal Access Request Form must be completed for all staff that will use the Provider Portal and submitted to your AA Liaison.

Each organization must also assign a Primary Agency Security Administrator (PASA) as an agency point of contact who will have additional responsibilities as well. The PASA will need to go to the ABE Provider Portal Registration page and submit a Request for Primary Agency Security Administrator Approval after creating their ABE account.

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