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Elizabeth M. Whitehorn, Director

Provider Notice issued 12/07/07

NPI Reporting for the Pay-To Provider (Payee)

To:​ Enrolled Participating Providers and Pay-To Provider (Payees)​
Date:​ December 7, 2007​
Re:​ NPI Reporting for the Pay-To Provider (Payee)​

In an informational notice dated December 13, 2006, Healthcare and Family Services (HFS) stated that the mandated National Provider Identifier (NPI) only applied to the billing provider and providers were not required to report or submit the NPI for the pay-to provider (payee).

 

This notice is to inform you that in the near future, HFS will begin requiring that the NPI be reported to designate the pay-to provider (payee), which will replace our current requirement of reporting the 1-digit payee code to designate the appropriate pay-to provider (payee). 

To ensure that Medicaid providers do not experience denial of claims, lack of payment or inappropriate payments being made to the wrong payee, payees must request a unique NPI.  Payees need to share their NPI information with the providers, for the purpose of billing services to HFS.  Providers should immediately start reporting to HFS the NPI information for each designated payee.

HFS encourages providers that have not yet obtained NPIs to do so immediately.  In order for payments to continue, HFS requires that payees obtain a unique NPI for each payee number assigned by HFS.  To apply for an NPI, visit the National Plan/Provider Enumeration System (NPPES) Web site at https://nppes.cms.hhs.gov/

Providers and payees who have not reported their NPI information to HFS should do so immediately.   Please reference the following MEDI Web site to report your NPI information www.myhfs.illinois.govor use the Web-based application available to report NPI information.or use the Web-based application available to report NPI information.

For providers or payees who do not have access to the Internet, the Provider or Pay-To Provider (Payee) NPPES approval letter with a contact name and phone number should be faxed to 217-557-8800 or mailed to:

Illinois Dept of Healthcare & Family Services

Provider Participation Unit

PO Box 19114

Springfield, Il 62794-9114

Providers should continue to report the 1-digit payee code to designate their appropriate payee when submitting claims to HFS, until further notification. 

If you have any questions regarding this notice, please contact the Bureau of Comprehensive Health Services toll-free at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs