Informational Notice
To: Participating Medical Assistance ProvidersRe: Requirements for Enrollment and Revalidation in the New Enrollment System - Illinois Medicaid Program Advanced Cloud Technology (IMPACT)
This notice outlines the requirements for enrolling in or revalidating existing information in the new computer-based provider enrollment system, called Illinois Medicaid Program Advanced Cloud Technology (IMPACT).
What you will need to create an INITIAL enrollment in IMPACT
Initial Enrollment is the process a person or entity (who has not previously been enrolled in the HFS Medicaid Assistance program) uses to apply to actively participate as a provider in the Illinois Medical Assistance Program. If you are an agency or an entity who is a brand new provider, you can enroll any time after the grand opening on August 3, 2015.
(Please note: State Agency-specific enrollment requirements will remain in effect in addition to the IMPACT enrollment requirements listed below.)
If you are an individual provider that serves Medicaid clients, but are not currently required to be enrolled in the Medicaid Management Information System (MMIS/Legacy), you must enroll in the IMPACT system beginning in 2016. (Some examples of these individual providers include: emergency medical technicians, drivers, dispatchers, home makers, interns.)
If you are an agency/entity provider, the following is what you will need in order to enroll:
- A National Provider Identifier (NPI) Number:
Not all providers are required to have an NPI Number. You are required to have an NPI if you are a health care provider who is a HIPAA-covered entity -- whether you are an individual or an organization, you must obtain an NPI. Under HIPAA, you are a covered health care provider if you electronically transmit health information in connection with a HIPAA standard transaction, even if you use a business associate to do so.
To get an NPI visit the National Plan & Provider Enumeration System website at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do (For more information and to access a tool to help you determine whether you are a covered entity, visit http://www.cms.gov/Regulations-and- Guidance/HIPAA-Administrative-Simplification/HIPAAGen Info/AreYouaCoveredEntity.html on the CMS website.)
- A certified W-9 tax form on file with the Comptroller:
- A Taxonomy Number:
- Licensures or certifications, as needed:
- Illinois Professional Licenses
- Out of State Medical Licenses
- American Board of Medical Specialties (ABMS)
- Clinical Laboratory Improvement Amendments (CLIA)
- American Board for Certification in Orthotics, Prosthetics, and Pedorthics
- Behavior Analyst Certification
- Deaf/Hard of Hearing Commission License
- Medicare Certification
- Board of Optician/Contact Lens Certification
- Federal Aviation Administration Certification (More information may need to be included regarding licenses and certifications)
- Other information verified by IMPACT
- Criminal History Background Check
- Drug Enforcement Agency Number
- Sanctions
- Vital Statistics
- Provider Basic Information
- Driver's License/State ID
- Vehicle Plate Number
- Vehicle Identification Number
- Safety Training Certificate
- A valid email address
- A supported browser:
- Internet Explorer (Version 8 through 11)
- Chrome
- Firefox
- Safari
Revalidation is the process a person or entity currently enrolled in the Illinois Medical Assistance Program uses to verify and update their enrollment information on file in IMPACT. Some provider information from the legacy MMIS system will be automatically converted and stored in IMPACT. You will be required to revalidate before the end of 2015.
This revalidation period applies to entities and sole providers seeking to become Illinois Medical Assistance providers, including those working under Waiver Programs administered by agencies other than the Department of Healthcare and Family Services. Additionally, revalidation must occur in a particular sequence so that associations may occur between entities and individual providers. Facilities, Agencies and Organizations (FAOs) must revalidate first, before any individuals (Sole Proprietors or Rendering/Servicing) can associate with these entities.
If you are currently enrolled in the MMIS, in addition to the relevant enrollment requirements listed above, in order to revalidate your information in IMPACT you will need the following:
- Your application ID number:
Providers that are not currently enrolled in IMPACT will not receive an Application ID.
Application IDs will only be mailed to providers who are currently enrolled in the Medical Assistance Program. Groups and payees are not currently enrolled; therefore they will not receive the yellow sheet with the Application ID.
If you do not receive or do not have your application ID, Help Desk operators can look up your number. The help desk will need the provider’s name, Social Security Number (or Tax ID Number), Date of Birth (if applicable) and NPI. You can contact the IMPACT Help Desk by email at: IMPACT.Help@Illinois.gov ) or by phone: (877) 782-5565 (Select option #1, and ask to speak with IMPACT staff). Or you can obtain more information from your funding agency.
More information is available at the IMPACT website http://www.illinois.gov/hfs/impact/Pages/default.aspx
Additional details will be posted as new information becomes available.
Please check the IMPACT website periodically for updates.
Contact the IMPACT Help Desk
- By email (IMPACT.Help@Illinois.gov)
- Or by phone: (877) 782-5565 (Select option #1, and ask to speak with IMPACT staff).
