You must submit the following forms:

If not enrolled for DHS billing through the Reporting of Community Services (ROCS) system, the billing agency, group practice or limited liability corporation (LLC) completes the following Medicaid Waiver enrollment forms:

You must obtain your National Provider Identification Number

Send the completed documents to the address below:

Department of Human Services
Division of Developmental Disabilities
319 E. Madison Street, Suite 3M
Springfield, IL 62701
Fax:  (217) 558-2799

Attention:  Provider Enrollment

Important Resources for Requirements