What is it?
- Adaptive Equipment services include: performing assessments to identify type of equipment needed, devices, controls or applicances to increase individuals' abilities to perform activities of daily living, or to perceive, control, access or communicate with the environment in which they live.
- Assistive Technology devices are: items, pieces of equipment or product systems, whether commercial, modified or customized. These devices are used to increase, maintain or improve functional capabilities of individuals. Individuals are assisted in the selection, acquisition and use of an assistive technology device.
How Do I Become A Provider?
1. You must submit an IRS W-9. Please review the IRS Guidelines to ensure that your W-9 is completed correctly. Incorrectly completed W-9s may result in significant delays in the enrollment
Department of Human Services
Division of Developmental Disabilities
600 East Ash Street, building 400, Mail Stop 2 South
Springfield, IL 62706
Attention: DD Provider Enrollment
2. You must submit an IMPACT provider enrollment application to enroll as a Medicaid Waiver provider.
All users to the IMPACT system must have a Single Sign-On ID to access the provider enrollment system. Once the User has been granted access to the provider enrollment system, the user may begin the provider enrollment application for your agency.
The first step in the provider enrollment application is selecting the enrollment type. Individuals will be enroll using the Atypical Individuals enrollment type. Companies will select the enrollment type Atypical Agencies. Please use the PowerPoint presentations available on the DDD IMPACT Provider page to walk you through each step of the applications.
The application must include the following information:
- Step 3, Add Specialty: Assistive Equipment; Adaptive Equipment/Assistive Technology; No Subspecialty
- Note: Some products/services may also fall under the category of Home Modifications and providers may want to add the additional specialty for that service: Social Services; Environmental Modification; No Subspecialty.
- Step 6, Associate Billing Agent: Billing Agent ID number 7094638; Billing Agent Name: DDD Billing Agent
- Step 9, Associate MCO Plan: MCO Plan ID number 3000006; Plan Name: DDD MCO
After submitting the IMPACT application, please email Provider Enrollment the IMPACT application ID to ensure that the application is reviewed by a DDD Provider Enrollment Specialist.
How do I bill for this service?
Please review the following options:
- Participants who utilize this service may request that a DD primary service provider submit the billing on behalf of the Adaptive Equipment/Assistive Technology provider. If the primary service provider agrees, the Adaptive Equipment/Assistive Technology provider will need to complete a Payee Designation/Authorization Form (IL462-1180) and maintain a copy of the form on file with the primary service provider.
- Providers may submit a Fee-For-Service Programs - Request For Payment - Billing By Provider - Event (pdf) (IL462-1177) form to the address below. Please follow the Instructions for IL462-1177 to ensure that the form is completed correctly.
- Administrative Voucher Unit
- Department of Human Services
- Harris Building - 1st Floor
- 100 South Grand Avenue East
- Springfield, IL 62762
- Adaptive Equipment/Assistive Technology providers that are frequently chosen to provide services or products for multiple DD waiver participants may request access to the DHS electronic billing system. Please note the computer requirements for using the Community Reporting system (ROCS). Please contact DD Provider Enrollment for more information.