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  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 10/06/04

Applications for the State Chronic Renal Disease Program

To:​ Participating Hospitals and Renal Dialysis Facilities​
Date:​ October 6, 2004​
Re:​ Applications for the State Chronic Renal Disease Program ​

The department is pleased to announce the addition of the application forms for the State Chronic Renal Disease Program to the Web site. The forms can be found at <http://www.dpaillinois.com/renalprogram/>.

The forms may be downloaded and used for enrollment processing. The completed forms cannot be submitted to the department via the Web site, due to the requirement for an original signature on all application forms. Instead the completed, signed form must be mailed.

Questions regarding this notice should be directed to the Bureau of Comprehensive Health Services at 217-782-5565.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs