Illinois Application Service Provider Agreement
Description
How to fill out Application Service Provider Agreement?
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FAQ
HealthChoice Illinois is the statewide Medicaid managed care program.
To get more information on applying for Medicaid, please contact the Health Benefits Hotline at 1-800-843-6154.
1-800-842-1461. To use the automated system, you must have the individual's Medicaid Recipient Identification Number (RIN) and the date of service for which you need eligibility information. If you do not know the individual's RIN, you need the individual's name, birthdate and SSN and must talk with hotline staff.
The federal government is now ending continuous Medicaid coverage on March 31, 2023. Starting April 1, Illinois Medicaid must review eligibility for all Medicaid cases. This process is called redetermination.
If you aren't sure if your Medicaid coverage has been approved yet or if it is still active, you can check Manage My Case or call the state's Automated Voice Recognition System (AVRS) at 1-855-828-4995 with your Recipient Identification Number (RIN).
Provider Help Line: 1-800-804-3833.
Provider Help Line: 1-800-804-3833.
Be a resident - The applicant must be considered a resident of the state of Illinois. There is no minimum length of time for the person to have lived in Illinois. Be a citizen or an eligible non-citizen - The applicant must be a citizen of the United States or an immigrant legally admitted for permanent residence.
Enrollment in the Illinois Medical Assistance Program requires the complete of an application and determination of your eligibility prior to the assignment of a provider number. All providers are required to complete, sign, and date a Provider Agreement (HFS1413) and an Enrollment Disclosure Statement (HFS1513).
HealthChoice Illinois is the statewide Medicaid managed care program.