CONTACT US FOR ADDITIONAL HELP
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Healthcare & Family Services (Public Aid) Websites +
ILLINOIS: http://www.hfs.illinois.gov/enrollment/
WISCONSIN: http://www.forwardhealth.wi.gov
INDIANA: http://provider.indianamedicaid.com/general-provider-services/forms.aspx
ADOBE READER: http://get.adobe.com/reader/
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Physician providers NOT enrolled for Illinois Public Aid/Medicaid +
Required forms:
2243 -- http://www.hfs.illinois.gov/assets/hfs2243.pdf
1413 -- http://www.hfs.illinois.gov/assets/hfs1413.pdf
1513 -- http://www.hfs.illinois.gov/assets/hfs1513.pdf
2306 -- http://www.hfs.illinois.gov/assets/hfs2306.pdf
2307 -- http://www.hfs.illinois.gov/assets/hfs2307.pdf
W9 -- http://www.irs.gov/pub/irs-pdf/fw9.pdf
Copy of license
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Providers enrolled as an Illinois Medicaid provider +
Required forms:
2306 -- http://www.hfs.illinois.gov/assets/hfs2306.pdf
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Illinois Medicare Part B Website +
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NEW Medicare Part B Illinois providers in solo practice +
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NEW Medicare Part B Illinois providers joining existing group practices +
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Current Medicare Part B Illinois providers joining a group +
Required Form:
855R -- https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms855r.pdf
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