You must submit the following forms:


Your agency must submit the following forms: 

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 to Janene.VanBebber@illinois.gov:

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

All health care bills submitted electronically to any DHS program will be denied if the provider of health care services does not have an NPI number registered with HFS. Your NPI number is registered by HFS at the time of enrollment. The NPI number is entered on your form HFS 2243.

Important Resources for Requirements