A CMHC organization wanting to change the Pay-To-Address linked to all site enrollments in IMPACT, operating under the organization's single Employer Identification Number (EIN)/Tax Identification Number (TIN), must carry out the following steps. A CMHC organization is not able to modify the Pay-To-Address linked to any site enrollment in IMPACT as varying Pay-To-Addresses for a single EIN/TIN are not allowed. The IMPACT System only allows for a single Pay-To-Address per EIN/TIN.
If questions or in need of assistance with the process, contact the IMPACT Help Desk at IMPACT.Help@illinois.gov or 877-782-5565 - Option: 1, 2 & 1
1. Notify IMPACT Help Desk
Written notification of the change in Pay-To-Address must be submitted to the Illinois Department of Healthcare and Family Services (HFS) IMPACT Help Desk at IMPACT.Help@illinois.gov. The notification must be on office letterhead, signed by someone in authority from the organization, and include the:
- Employer Identification Number (EIN)/Tax Identification Number (TIN) of the CSP organization
- Current Pay-To-Address
- New Pay-To-Address
- NPI numbers for all enrolled sites operating under the Organizational EIN/TIN
- Primary contact name and title
- Primary contact mailing address, email address and telephone number
If the address listed on the previous W-9 submitted to the Illinois State Comptroller for EIN/TIN certification needs to be updated, a new W-9 should be submitted along with the notification. "Change of Address" should be written across the top of the W-9.
2. IMPACT System Updated
HFS-Provider Enrollment (PE) Unit shall update the IMPACT System to reflect the new Pay-To-Address for all enrollments operating under the organization's EIN/TIN. The organization shall receive a systematically generated email from the IMPACT System, for each enrollment, signifying the transaction being completed.
