Provider Connections

New HFS 1413 Enrollment Agreement Required

Effective July 1, 2014, the Illinois Department of Healthcare and Family Services updated the Agreement for Participation in the Illinois Medical Assistance Program (HFS 1413). This agreement is part of the Central Billing Office Enrollment Application materials posted on the Provider Connections’ website. HFS has informed Provider Connections that, effective July 1, 2014, prior versions of this agreement will not be accepted. Therefore, we are asking that all prior versions be destroyed in lieu of the current document.

Applicants who are currently “In Process” were sent an email notice of this change on July 30, 2014, with the new HFS 1413 document attached. The email notification requested the forms be completed and MAILED to Provider Connections due to HFS’ original signature requirement.

Provider Connections will continue to notify new applicants who submit the old HFS 1413 documents as necessary. We apologize for any inconvenience. Thank you for your patience.

Sincerely,

Provider Connections

Provider Connections

Contact Info

Provider Connections
Center for Best Practices in Early Childhood Education
Western Illinois University
1 University Circle
Macomb, IL 61455

Phone:  800-701-0995
Fax:  309-298-3066
Email: providerconnections@wiu.edu

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