Agencies
Services
Provider Notice issued 10/23/2025
I52 – Attending NPI Wrong Provider Type
I53 – Attending NPI Not Enrolled or Inactive
Implementation of New Claim Edits for Attending Provider National Provider Identifier (NPI)
| 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 | October 23, 2025 |
| Re: |
Implementation of New Claim Edits for Attending Provider National Provider Identifier (NPI) |
This notice informs Long Term Care providers of new claim edits regarding the Attending Provider National Provider Identifier (NPI) and to clarify the Provider Notice Issued 09/10/25. Please note that while the previous notice mentions the ordering/ORP NPI being required, the attending NPI will be used in claim editing to meet the Payment Error Rate Measurement (PERM) audit requirements.
The Attending Provider NPI field is required for all long term care (LTC) claims, and the Department (HFS) already edits claims to ensure the Attending Provider NPI is valid. As a result of the federal audit finding, the Department will implement two new edits to ensure that the Attending Provider is of the correct provider type and is enrolled on the date of service.
Effective with dates of service on and after January 1, 2026, the Department will reject claims if the Attending Provider is not enrolled with the Department on the date of service. Any Attending Provider not enrolled must go to the Illinois Medicaid Program Advanced Cloud Technology (IMPACT) home page to start the enrollment process. Claims will also be rejected if the Attending Provider is not of one of the following provider types:
Provider Type Code
|
Provider Type Description
|
010
|
Physicians
|
011
|
Dentists
|
012
|
Optometrists
|
013
|
Podiatrists
|
016
|
Nurse Practitioners
|
089
|
Physician Assistant Only (Encounter Only)
|
Claims with dates of service beginning January 1, 2026, will be rejected with the following messages if the Attending Provider NPI does not pas editing:
Please note that these edit changes were incorrectly implemented early and caused some claims with dates of service prior to January 1, 2026, to reject. Providers will need to resubmit any claims that were incorrectly rejected.
These edits will not apply to claims where the billing LTC Provider is an out of state non-cost reporting provider.
In an effort to assist providers in verifying enrolled Attending Providers in the IMPACT system, the Department has made available an Illinois Medicaid Provider Directory housed on the IMPACT home page. If no results are returned, then either the provider is not enrolled, or the enrollment has been end-dated.
Questions regarding this notice should be directed to the Bureau of Long Term Care at HFS.LTC@Illinois.gov.
Laura Phelan, Administrator
Division of Medical Programs