What is it?
- Home accessibility modifications include: physical adaptations to the private residence of the individual or their family. The modifications would be specified by the individual's service plan, necessary to ensure the health, welfare and safety of the individual and enable the individual to function with greater independence in the home. Home accessibility modifications may or may not be permanent.
- Vehicle modifications are: adaptations or alterations to an automobile or van that is the individual's primary means of transportation. These modifications are specificed by the individual's service plan, necessary to ensure the health, welfare and safety of the individual and enable the individual to integrate more fully into the community.
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, Building 400, Mail Stop 2 South
Springfield, IL 62703
Fax: (217) 217-557-7251
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: Social Services; Environmental Modification; No Subspecialty
- Note: Some products/services may also fall under the category of Adaptive Equipment/Assistive Technology and providers may want to add the additional specialty for that service: Assistive Equipment; Adaptive Equipment/Assistive Technology; 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:
1. 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
2. Home or Vehicle Modification 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). You may contact DD Provider Enrollment for more information.
3. Participants who utilize this service may request that a DD primary service provider submit the billing on behalf of the Home or Vehicle Modification provider. If the primary service provider agrees, the modification 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.