Illinois_Medicaid_Provider_Enrollment_Individual_Practitioner_(3.19.19).... (1).docx

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1Illinois Medicaid Provider Enrollment Step-by-Step GuideLink to the Illinois Medicaid Enrollment website: The following information will be required within the online application.Professional License NumberNurse License DocumentationSSN and date of birth Your National Provider Identifier (NPI) NumberStarting ApplicationTo begin application click “login”.
2Create AccountClick the green button on the bottom of the screen to create an account.Step 1Select Service Provider/ Billing Agent then click continue.
3Step 2Insert your name, email and phone number then answer the security question.
4Step 3Create a user name and password and select four unique security questions. Be sure to write down and save your user ID, password and security questions and answers.Once your account is created, select “Request application access” to begin the application.
5Confirm AccountTo confirm your account, click “State of Illinois” then in step 2 select IMPACT. Request access and procced to the next page where you will agree to the terms and conditions.

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Term
Spring
Professor
snutg
Tags
Login, Luser, National Provider Identifier

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