Provider Notice issued 02/02/2026

Updated Universal Provider Roster for Illinois Medicaid Managed Care Organizations

This notice is to inform all participating Medical Assistance Program Providers that the provider enrollment roster template, located on the Illinois Association of Medicaid Health Plans (IAMHP) website,  Illinois Association of Medicaid Health Plans, has been updated effective February 1, 2026.  Please note that the previous template will no longer be available or accepted by HealthChoice Illinois Managed Care Organizations (MCOs) after January 31, 2026. 

Pursuant to 305 ILCS 5/5-30.1 (g-10) (1), the provider enrollment roster template is standardized across all HealthChoice Illinois Managed Care Organizations (MCOs). The updates in the template include:

• The Group/Location tab has been renamed to the Group/Agency tab.

• The addition of several fields in the Practitioner tab that capture the HIPAA compliance and accessibility of telehealth services at the practitioner’s location.

• The addition of two fields in the Practitioner tab that capture the ethnicity and race for all practitioners.

• The switching of the “Location Phone” field and the “Appointment Phone” fields in the Practitioner, Group/Agency, and Facility tabs.

• The Instructions and Directions tabs across all provider types have been updated to reflect the above changes.

The process and cadence for submitting the standardized roster remains the same. Medicaid providers must complete the standardized roster when making changes to all HealthChoice Illinois network listings. To assist with more timely credentialing and provider load, it is prudent to complete and send the roster to the MCO at the same time you submit your IMPACT application or modification or have changes or updates to your practice or agency (e.g. provider name changes, office location updates, new providers joining a practice, etc.). Timely updates will ensure the MCOs' directories are current, and accurate payments to providers can be made. All licensed roster staff providing direct care services in your organization must be added to the roster.

The universal format addresses the information needs of individual providers, group practices and facilities. Additionally, the format ensures compliance with recent Centers for Medicare & Medicaid Services rules on the scope of information that should be made available to Medicaid beneficiaries in provider directories. The provider roster cannot be used for credentialing providers. Effective January 1, 2018, HFS assumed the sole responsibility for credentialing through the State's IMPACT registration system.

In addition to the updated roster, MCO specific instructions and a list of Frequently Asked Questions can be found here: Illinois Association of Medicaid Health Plans.

Laura Phelan, Administrator
Division of Medical Programs