HFSMedical ProvidersCare Coordination

Managed Care Provider Complaints

HFS recognizes the importance of providers having an outlet for reporting issues they may have with Medicaid Health Plans if they cannot get these issues resolved by working through the Plan processes.  The provider portal was created for providers to submit complaints to HFS about issues you are experiencing with Illinois Medicaid Managed Care Organizations (MCOs) in an electronic and secure format.

Our goal is to answer MCO-related questions promptly and ensure fair resolution of disputes involving MCOs and providers.   Please allow HFS 2 business days to reply to an urgent complaint (immediate prescription needs or access to care needs, for example) and 15 business days for all other issues. 

Please read before submitting an MCO complaint:

 
  • This form should be completed only by providers with complaints involving Illinois Medicaid MCOs.
  • In order for your concern to be reviewed by HFS staff, your complaint must have first been reviewed by the MCO in question.   If HFS staff learn your complaint was submitted prior to working with the MCO for resolution, your complaint may be closed without HFS review.
  • Please complete one form per MCO.
  • If you have several members, dates of service, claims, authorizations, etc. affected by the same problem for the same MCO, you must upload an attachment with the information into one complaint rather than submitting individual complaints for each.

  • You may upload private health information securely on this portal; to do so you must have specific member detail, including the member’s name, HFS 9-digit recipient identification number, and date of service.  

  • Provider complaints regarding the resolution of Medicaid Fee-for-Service issues should continue to be directed to HFS at 877-782-5565.

     

 

 

 Illinois' Medicaid Managed Care Organization (MCO) Provider Complaint Form

 
Billing Agent IndicatorIs this a Billing Agent or Provider filing the complaint? If Yes, enter Billing Agent Name below.
Preferred Contact Method required
MCO Contracted requiredAre you or your provider group contracted with this MCO?
MCO Contacted requiredHave you already contacted the MCO about this issue?
Related ComplaintIf Yes, please provide an explanation below in the Complaint Summary area and the original Tracking Number in the box below.
Member InfoAre you uploading specific member information? If so, choose Yes and enter all Member fields below.
 
 
 

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