IMPACT Provider Enrollment

IMPACT (Illinois Medicaid Program Advanced Cloud Technology) is a NEW provider enrollment system to replace Illinois' 30-year-old Medicaid Management Information System (MMIS) with a web-based system that meets federal requirements, is more convenient for providers, and increases efficiency by automating and expediting state agency processes.

IMPACT Forms

IMPACT has been adopted in response to new federal requirements under the Affordable Care Act (ACA). This initiative is led by the Department of Healthcare and Family Services (HFS) who is responsible for the overall implementation strategy of IMPACT. The Illinois Department of Human Services, Division of Rehabilitation Services (DHS-DRS) is required to enroll all Individual Providers in the IMPACT system as an eligible Medicaid provider.

IMPACT & Home Services Program:

  • Beginning April 18, 2016, Individual Providers serving customers under the Home Services Program (HSP) are being enrolled in the IMPACT System as an eligible Medicaid provider
  • To ensure the enrollment process is handled timely and with minimal inconvenience to Individual Providers, HSP Central Office is handling the entire enrollment process
  • Individual Providers will begin receiving the Notice of Waiver Program Provider Agreement which they are required to sign and return to the local office.
  • This allows HSP to be able to receive Medicaid match for eligible providers


Individual Providers are required to do the following as soon as they receive the Notice of Waiver Program Provider Agreement:

  1. Please print your full legal name, include last 4 digits of SSN, sign and date the Notice of Waiver Program Provider Agreement. By signing this form, you are acknowledging that your are notified and aware of your enrollment in the IMPACT Medicaid Provider Enrollment System.
  2. If you are a CNA/LPN/RN without a National Provider Identifier (NPI), you MUST obtain a NPI to be enrolled in the IMPACT System.
    Please visit https://nppes.cms.hhs.gov to obtain a NPI.
  3. Obtaining your NPI will require the entry of a Taxonomy Code to process your request. The following Taxonomy Codes are recommended based on your Provider Type:
    CNA: 376K00000X
    LPN: 164W00000X
    RN : 163W00000X
  4. Please return this form to the DRS local office where you submit your timesheet as soon as possible.


Enrollment into the IMPACT system is a federal requirement under the Affordable Care Act and failure to comply could result in the Individual Provider being unfunded as an eligible provider under the Home Service Program.


Additional Resources:

Providers with questions about where to submit their signed Notice of Waiver Program Provider Agreement, should contact their local DRS office.


National Provider Identifier: To obtain a NPI, please visit https://nppes.cms.hhs.gov

Providers with general questions about IMPACT should contact: