Skip to main content
  • 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 01/19/2024

 

To: Enrolled Hospitals:  Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers
​Date: ​January 19, 2024
​Re: Hospital Enrollment as Pharmacy Provider Type to Bill Opioid Antagonist Dispensing Fee 

This notice informs hospitals of the process to submit a claim for the dispensing of opioid antagonist medication, including naloxone hydrochloride or any other similarly acting drug approved by the U.S. Food and Drug Administration, in the hospital emergency department.

To comply with the conditions in Public Act 102-0598, the Department of Healthcare and Family Services (HFS) will require hospitals that do not already have a separate pharmacy enrollment to enroll as a pharmacy Provider Type through the IMPACT system. Hospitals must have this separate pharmacy enrollment in order to bill for the dispensing fee for the above medications given in the hospital emergency department setting.

For Medicaid fee-for-service (FFS) claims, dispensing fees will be billed through HFS’ Illinois Rx Portal Pharmacy Benefits Management System (PBMS), separate from 837I emergency department claims.

For managed care customer claims, dispensing fees must be submitted to the individual managed care organization’s (MCO) PBMS.   

Hospitals must ensure the pharmacy enrollment has proper contracting and authorization before claim submittal to the MCOs and FFS program. 

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate MCO.

 

 

Kelly Cunningham, Administrator
Division of Medical Programs