Provider Notice issued 03/25/2024

The Department is pleased to announce that the claims processing application has been restored as of March 23, 2024.

HFS deeply appreciates our pharmacy partners and their continued patience, understanding, and dedication to meeting the needs of our Illinois Medicaid customers during the unprecedented Change HealthCare nationwide outage and the restoration of the Pharmacy Benefit Management System (PBMS) for the Department’s fee-for-service billing application.

Please resume the processing of all claims and begin submitting claims for drugs that were dispensed during the outage. There will be no daily limit on the number of claims submitted by enrolled pharmacies. Claims will be paid daily as they were before the outage. Additional applications within the PBMS remain inaccessible and will be restored at a later date.

If your pharmacy has charged Illinois Medicaid customers for prescriptions filled since February 21, 2024, please reimburse the IL Medicaid customer immediately.  

During this restoration process, we will continue to suppress prior authorization (PA) edits, including Preferred/Non-Preferred status, Refill Too Soon (RTS), Third Party Liability (TPL), and Four Prescription Policy (4Rx).

Although PA requirements are currently lifted, we urge you to examine the Preferred Drug List (PDL) Medicaid Preferred Drug List | HFS (illinois.gov) to best navigate prior authorization criteria and drug coverage.

Pharmacies should continue to check eligibility via:

·MEDI – www.myhfs.illinois.gov
·AVRS – 800-842-1461
·Recipient Eligibility Verification (REV) System
·The Prior Approval and Refill Too Soon (PARTS) Hotline at 800-252-8942

For questions regarding claims submissions, contact the Pharmacy Billing Consultant Hotline at 877-782-5565 Option 7.

Please have patience as we expect higher than average call volumes, as well as potential congestion with switch vendors. If you would like to set up an appointment to work directly with a billing consultant on submission of claims and troubleshooting any issues, please contact

Pharmacy Billing at HFS.PhcyBillingMAC@illinois.gov so that we can dedicate resources accordingly.

Please note the resumption of normal hotline hours for both PARTS and Pharmacy Billing Hotlines, Monday-Friday from 8:00am-5:00 pm.

Again, on behalf of our Medicaid customers and the entire team at the Department of Healthcare and Family Services, we extend heartfelt thanks to our enrolled pharmacies, pharmacists, pharmacy techs, pharmacy staff, and industry leaders who collaborated with us during this time to ensure customers had access to the prescription drugs and supplies they need for their health and wellness.

Kelly Cunningham, Administrator
Division of Medical Programs