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Elizabeth M. Whitehorn, Director

Provider Notice Issued 09/10/2025

        

To: Long Term Care (LTC) Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP), Medically Complex for the Developmentally Disabled Facilities (MC/DD) and Specialized Mental Health Rehabilitation Facilities (SMHRF)
​Date: September 10, 2025
​Re:
 PERM Audit Findings – Long Term Care

This notice serves as a reminder that all services for which charges are made to the Department of Healthcare and Family Services (HFS) are subject to audit. Audits are an essential part of the Department’s monitoring of healthcare facilities and services, as required by federal and state law. 

The federal Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) has implemented a Payment Error Rate Measurement (PERM) program, which measures improper payments within each state's Medicaid Program and Children’s Health Insurance Program (CHIP). Each state is required to participate in a PERM audit every three (3) years.  

For more information about PERM audits, please see the HFS Office of Inspector General’s (OIG) PERM website.

Reporting Year 2025 PERM Review

The PERM audit for reporting year (RY) 2025 (claims paid on/between July 1, 2023, and June 30, 2024) was conducted and resulted in the following errors being cited: 

  1. Provider Enrollment  

         ·  Provider information/enrollment error cited: Ordering providers listed on claims were not enrolled providers at the time of service. 
         ·  Providers must be enrolled in the Medicaid program to receive payment.  
         · Please note that a new claim edit will be implemented that will reject claims for unenrolled providers, making it imperative that providers are enrolled to receive payment.

     2.   National Provider Identifier (NPI): 

         · Provider information/enrollment error cited: ORP Type 1 NPI required but not listed on claim; claims submitted for Intermediate Care Facility (ICF) services without
          an ordering provider NPI. 
        · All claims submitted for Intermediate Care Facility (ICF) services must include the ordering provider's NPI to receive payment.   
        · Missing NPI is a cause for rejection of claims. 

Providers are reminded that they must be enrolled in the Medicaid program to receive payment.  

  • Federal regulations at 42 CFR 455. Subpart E outline the requirements for provider screening and enrollment in the Medicaid program.

  • The Illinois Handbook for Providers outlines provider enrollment policies and procedures in Chapter 100/Section 101.

  • Illinois Administrative Code, 89 Ill. Adm.. Code 140.11, outlines enrollment conditions for Medicaid providers to receive payment.

The ordering provider NPI must belong to an enrolled provider, and the NPI must be included on all claim submissions (42 CFR 455.410).

Questions regarding this notice should be directed to the Bureau of Long-Term Care at 1-844-528-8444.

 

Laura Phelan, Administrator
Division of Medical Programs