MedicaidAdministrativeMedium impact
Addendum to June 27, 2011 Provider Bulletin Reporting of Other Operating Physician Name and NPI (pdf) (html)
Illinois Medicaid - HFS·IL · General Surgery, Cardiothoracic Surgery, Neurosurgery +5 more·Provider Notice
Effective date
Oct 28, 2011
We identified it
Jun 21, 2026
Summary
For institutional claims with surgical procedures, when reporting an Other Operating Physician Name and NPI, the primary Operating Physician Name and NPI must also be included on the claim. Claims with Other Operating Physician information but missing primary Operating Physician information will be rejected as non-compliant.
Action Required
Immediately: Billing team must update claim submission processes to ensure primary Operating Physician Name and NPI are always included when Other Operating Physician information is reported on institutional claims for surgical procedures. Update billing system validation rules to prevent submission of claims with Other Operating Physician data but missing primary Operating Physician data. Non-compliant claims will be rejected.