How Do I Become A Provider?

  1. You must submit the following forms, Encrypted, to or the address provided below:

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

    Attention: Provider Enrollment

    Note:  The Payee Designation/Authorization Form should be kept by you and by the agency for which you work for audit purposes.  The Department of Human Services does not retain a copy of this document.

    • Copy of certification or licensure. 
    • If you are a Level 1 or Level 2 Behavior Intervention Services provider, you must submit your approval letter.
  2. If the agency for which you are working is not enrolled for DHS billing through the Reporting of Community Services (ROCS) system, the agency must complete the following forms and submit them, Encrypted, to or the address provided in #1:

  3. You must obtain your National Provider Identification Number

    All health care bills submitted to any DHS program will be denied if the provider of health care services does not have an NPI number registered with HFS.

Important Resources for Requirements