One key aspect of eligibility is patient volume. To qualify for an incentive payment under the Illinois EHR Medicaid Incentive Payment Program, an eligible professional must meet one of the following criteria for Medicaid patient volume:

  • Have a minimum 30% Medicaid patient volume
  • Have a minimum 20% Medicaid patient volume, and be a pediatrician

Clinics or group practices will be permitted to calculate patient volume at the group practice/clinic level only in accordance with all of the following limitations:

  • The clinic or group practice's patient volume is appropriate as a patient volume methodology calculation for the EP
  • There is an auditable data source to support the clinic's or group practice's patient volume determination
  • All EPs in the group practice or clinic must use the same methodology for the payment year
  • The clinic or group practice uses the entire practice or clinic's patient volume and does not limit patient volume in any way
  • If an EP works inside and outside of the clinic or practice, then the patient volume calculation includes only those encounters associated with the clinic or group practice, and not the EP's outside encounters.


For 2019, patient volume pre-approval is required. Provide the following information to HFS at

     Payee TIN =

     Payee NPI =

     Group or individual numbers?

     Provider type:  (physician, hospital, dentist)

    Selecting a Date Range: (Select Calendar Year 2018 only for Pre-Approval
- Date Range: Calendar Year, any 90-day period in 2018  ___________
      - Can not use the same date or overlap date used for Attestation Year 2018

     Straight Medicaid (only traditional Medicaid & All Kids) =

     Straight Medicaid Managed Care =

     Total Encounters for all payees =


Promoting Interoperability Program Eligibility