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  • 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
The online application below is to be utilized by currently enrolled Illinois Medicaid Providers to request a change(s) or update(s) to their Medicaid Provider information.  The application, in many cases, will replace the need for a current Provider to submit a paper HFS 2243, HFS 2306, HFS 2307 for change(s) or update(s) for the following:  Update NPI, update/change Name, update/change provider demographics (address, telephone, e-mail), update/change payee demographics (address, telephone, e-mail), add a payee, close a payee, close a Provider file, update/change a license, add/update a CLIA. 
In some instances, it will be necessary for state staff to contact the submitter to obtain additional information to complete the request
Requests utilizing the form below will be expedited.       

HFS Provider Update Form
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Provider Acceptance Required