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Provider Notice Issued 06/16/2021
Date: June 16, 2021
To: Advanced Practice Nurses and Physicians
Re: Chapter A-200, Handbook for PractitionersRendering Medical Services
Claim Submission Policy Update forServices Rendered by Advanced Practice Nurses Effective with Dates of Serviceon and after September 1, 2021
This bulletinclarifies billing requirements for services rendered by Advanced PracticeNurses. This billing policy applies to services submitted under the Medicaidfee-for-service program, a HealthChoiceIllinois managed care plan (including YouthCare), or the Medicare-MedicaidAlignment Initiative program.
TheDepartment had historically allowed the services of an APN to be billed underthe collaborating physician’s name and NPI, as permitted under the Code ofFederal Regulations at
42 CFR441.22(c). However, later guidance under 42 CFR 455.410 containsprovider screening and enrollment requirements prompted by the Affordable Care Actthat state all professionals providing services under the State Plan or under awaiver of the Plan be enrolled as participating providers.
Effective with dates of service beginning September 1, 2021, claimsmust identify the APN as the rendering or ordering/referring/prescribingprovider as applicable with the APN’s name and NPI. Services may not be billedunder the collaborating physician’s name and NPI.
APNs providing services must be enrolled as aRendering/Servicing provider in IMPACT. APNs not already enrolled should follow thesteps on the IMPACT webpage.
The Handbook for Practitioners Rendering Medical Services has been updated toreflect the new policy. Questions regarding this bulletin may be directed tothe Department’s Bureau of Professional and Ancillary Services at 877-782-5565,or to the applicable managed care plan.