Licensed Clinical Psychologist - Developmental Disabilities

Qualifications: Professional with valid Illinois clinical psychologist license.

How Do I Become A Provider?

1. Obtain a National Provider Identifier from the National Plan and Provider Enumeration System. 
   1. The NPI must be a Type 1- Individual.
   2. The taxonomy code should align with your license and services that you be providing. 
2. Send a copy of your current license to:  DHS.DDDMedProv@illinois.gov .
3. Submit an IMPACT provider enrollment application to enroll as a Developmental Disabilities Medicaid Waiver Provider.
4. You must create an IMPACT account on the IMPACT login page.  Please use the Single Sign-On ID PowerPoint Presentation found on the IMPACT Presentations and Materials page on the HFS website to complete this step. 
   1. When the Single Sign-On ID has been approved, return to the IMPACT login page and log into your account.  There will be a blue IMPACT hyperlink located on the IMPACT home page under the 4 green boxes.  Click on the IMPACT hyperlink to access the IMPACT Provider Enrollment System. 
   2. Click on NEW ENROLLMENT. On the next screen, select the Enrollment Type
      1. Individual/Sole Proprietor
      2. Regular Individual/Sole Proprietor or Rendering/Servicing Provider
   3. On the Basic information page, select the Applicant Type based on the definitions of Independent Sole Proprietor or Rending/Servicing Provider.  The links below provide instructions for the specific applicant types.
      1. Independent Sole Proprietor - A person that works independently and renders direct services to persons enrolled in the Developmental Disability Medicaid Waiver program.  Note:  This does NOT include persons that are the sole member of a LLC or owns and operates an incorporate business.
      2. Rendering/Servicing Provider - A person that renders services in the Developmental Disability Medicaid Waiver program as an employee or contracted provider for company or provider group. 
5. Send an email to DHS.DDDMedProv@illinois.gov to notify DHS, Division of Developmental Disabilities that your application has been submitted for state review. 

IMPORTANT UPDATE to Coverage of Adaptive Behavior Support Services for Children with Autism Spectrum Disorder:

The Illinois Department of Healthcare and Family Services issued a Provider Notice on 9/30/21 notifying Medical Assistance providers of an update in coverage of Adaptive Behavior Supports (ABS) for children with Autism Spectrum Disorder.  This coverage is for children with Medicaid Medical benefits.  DHS, Division of Developmental Disabilities does not operate this program and is unable to answer questions about this service. 

 ABS Technical Assistance and Support

• ABS policy and general ABS concerns: omi.support@uillinois.edu.
• Behavioral Health Provider IMPACT enrollment: omi.impact@uillinois.edu.
• Prior Authorization for ABS services requests: Hfs.abs@illinois.gov.
• Billing questions, Bureau of Professional and Ancillary Services: 877-782-5565.

Questions regarding ABS service coverage, prior authorization, and billing requirements for managed care enrolled customers should be directed to the appropriate HealthChoice Illinois MCO.