MedicaidAdministrativeMedium impact
Implementation of New Claim Edits for Attending Provider National Provider Identifier (NPI)
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Illinois Medicaid will implement new claim edits requiring Attending Provider NPIs to be enrolled and of specific provider types (physicians, dentists, optometrists, podiatrists, nurse practitioners, or physician assistants) for long-term care facility claims. Claims will be rejected if the attending provider doesn't meet these requirements.
Action Required
Before January 1, 2026: Long-term care facilities must verify all Attending Provider NPIs are enrolled in Illinois Medicaid and are valid provider types (physicians, dentists, optometrists, podiatrists, nurse practitioners, or physician assistants). Use the Illinois Medicaid Provider Directory on IMPACT home page for verification. Resubmit any claims incorrectly rejected due to early implementation of these edits. Claims will be rejected with codes I52 or I53 if attending provider requirements are not met.