How Do I Become A Provider?

If you have a business or group practice that will be billing and receiving payments on your behalf:

  1. The following documents must be submitted for your business/group practice to Provider Enrollment:

    Department of Human Services
    Division of Developmental Disabilities
    319 E. Madison Street, Suite 3M
    Springfield, IL 62701

    Attention: Provider Enrollment

  2. The business is required to have a type 2 - organizational National Provider Identifier Number (NPI). 

    Please see web site on National Provider Identification Number

  3. You must complete an online application for the business/group practice to enroll in the IMPACT provider enrollment system. Please visit the DHS/DDD IMPACT page for additional information specific to the DD Medicaid Waiver Program(s).The Group Practice enrollment type is designated in the DD Medicaid waiver programs for business entities that are providing behavior intervention and treatment services, counseling/psychotherapy, physical therapy, speech therapy and occupational therapies. The business entity is not providing any DD waiver services and is viewed as a billing provider for the individual therapists, counselors, etc. that are providing the Medicaid services. The purpose of enrolling the Group practice in IMPACT is to ensure that all entities billing for a Medicaid provider are properly screened as required by federal requirements. After submitting an IMPACT application, please email Provider Enrollment the IMPACT application ID to ensure that the application is reviewed by a DDD Provider Enrollment specialists.
  4. You and any additional Medicaid providers that works for the business will need to enroll in IMPACT as a Rendering/Service Provider. On Step 3 of the application, the provider will need to enter the NPI for the company/group as the billing provider.  After submitting an IMPACT application, please email Provider Enrollment the IMPACT application ID to ensure that the application is reviewed by a DDD Provider Enrollment specialist.


If you are working independently as an Individual/Sole Proprietor:

  1. The following documents must be submitted to Provider Enrollment:

    Department of Human Services
    Division of Developmental Disabilities
    319 E. Madison Street, Suite 3M
    Springfield, IL 62701

    Attention: Provider Enrollment

  2. You are required to have a National Provider Identifier Number (NPI). 

    Please see web site on National Provider Identification Number

  3. You must complete an online application to enroll as a Medicaid Provider using the IMPACT provider enrollment system.  You must enroll as an Individual Sole/Proprietor in IMPACT.  Please visit the DHS/DDD IMPACT page for additional information that is specific to enrolling as a DDD Waiver provider. After submitting an IMPACT application, please email Provider Enrollment the IMPACT application ID to ensure that the application is reviewed by a DDD Provider Enrollment Specialists.

Important Resources for Requirements