Provider Not Enrolled As Waiver Provider For the Service

This means that the service provider is not enrolled on the HFS Medicaid waiver provider database in the correct waiver or for the service that is being billed. See the Provider Information/Enrollment section in the Provider Waiver Manual Appendices for enrollment forms and instructions:

Timing and Enrollment Issues:

  • Providers must be enrolled in the waiver (adult, children's support, or children's residential) in which the individual being served. Separate enrollment packets are necessary if the provider is serving people in different waivers.
  • Providers must be enrolled in the category of service for the service they are delivering.
  • If you submitted the provider enrollment packet less than six weeks before the bill was rejected, the problem is most likely timing. It typically takes at least a month to process a new waiver provider enrollment. Try retransmitting the bills.
  • If you submitted the provider enrollment packet at least six weeks before the bill was rejected, send a FAX to Provider Enrollment at 1-217-558-2799 and request that staff check for a data entry error in the provider enrollment information or computer system.

Billing Errors:

  • Check that the service provider on the bill is the actual entity that delivered the service, not the payee. For example, the service provider for behavioral services and therapies is the professional, not the agency that employs the professional. Similarly, for home or vehicle modifications, the service provider is the vendor or contractor, not the agency that is seeking reimbursement for payments to the vendor.
  • Correct the service provider name and FEIN and SSN on the bill.

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