Provider Notice issued 01/11/08

Enrollment of Salaried Physicians and Advanced Practice Nurses (APNs)

This notice informs hospitals of a policy and billing change regarding salaried medical staff and their professional services in the hospital outpatient setting.

Effective with service dates on and after July 1, 2008, hospitals will no longer be able to bill for the professional services of salaried physicians and APNs under the hospital fee-for-service provider number.  The department will require fee-for-service claims to be billed under the name and provider number of the practitioner who renders the service.

This change will have the following benefits for hospitals, individual practitioners and the department:

• HFS’ hospital billing policy will be consistent with all other payers.

• Physicians and APNs practicing at hospital clinics will be able to enroll as a Primary Care Provider under Illinois Health Connect, HFS’ Primary Care Case Management (PCCM) program.

• HFS will be able to monitor the enrollment status of the practitioner who renders the service.

 When this change is implemented, all salaried physicians and APNs for whom claims will be submitted must be enrolled with HFS in order to be paid for their services.  HFS encourages hospitals to initiate the enrollment process for their non-enrolled physicians and APNs as soon as possible.  When enrolling, the physician or APN may choose to designate the hospital as a payee.

Enrollment information is available for downloading from the department’s Web site at: <http://www.illinois.gov/hfs/impact/Pages/default.aspx>.  Providers may also contact the Provider Participation Unit at:                                    

Healthcare and Family Services

Provider Participation Unit

Post Office Box 19114

Springfield, Illinois 62794-9114

Phone Number:  217-782-0538 / Fax Number:  217-557-8800

E-mail address is hfs.webmaster@illinois.gov

As a reminder, HFS encourages providers that have not yet obtained NPIs to do so immediately.  To apply for an NPI, visit the National Plan/Provider Enumeration System (NPPES) Web site at: <https://nppes.cms.hhs.gov/>.  Providers who have obtained NPIs, but have not reported their NPI information to HFS should do so immediately.  You may report your NPI information by going to the MEDI Web site at: www.myhfs.illinois.gov or by using a Web-based application available at: <www.illinoisnpi.com>.  In addition, providers should ensure that all of their payees have obtained and reported their NPIs to the department.  The informational notice on the NPI requirement sent to payees can be accessed on the department’s Web site at: <http://www.hfs.illinois.gov/all/>.

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs