HFS recognizes the importance of providers having an outlet for
reporting issues they may be having with an Illinois Medicaid Managed Care
Health Plan (MCO). Effective
February 28, 2020, all providers will be required to submit unresolved
disputes with an MCO to HFS via the new secure, web-based Provider Resolution
portal. Issues that are submitted in the new portal on or after February 28, 2020, will be processed under the new provider dispute resolution process
and applicable timeframes as required by Public Act 101-0209 (SB1321). The goal of the portal is to ensure fair resolution of
disputes involving MCOs and providers in an electronic and secure format.
Please
read before submitting a complaint
The
new provider dispute resolution process requires providers to first use the
MCO internal dispute process before submitting a complaint to HFS. Disputes submitted to the MCO internal
dispute resolution process may be submitted to the new HFS Complaint
Resolution Portal: 1) no sooner than
30 days after submitting to the MCO's internal process and 2.) no later than
60 days after submitting to the MCO’s internal process. If HFS determines a complaint was submitted sooner than
30 days or later than 60 days after submitting the dispute to the MCO’s
internal process, the complaint will be immediately closed. Under the MCO internal dispute process, MCOs are
required to assign the provider a standard tracking number for each complaint
submitted. The provider must enter this MCO-assigned tracking number in
the Provider Resolution portal when completing a complaint ticket.
- Providers
and MCOs are expected to also follow Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
procedures when submitting and sharing data via the portal.
All providers or designated billing staff/agents will be required to set
up an account to register with the portal in order to access and submit disputes.
Provider
complaints regarding the resolution of Medicaid fee-for-service issues should
continue to bedirected to HFS at 877-782-5565.
To Register or Sign On click the Login button below or click this link.
To Register: Enter your Email, choose a Username and Password, and click Register
On the Registration form, fill out all fields completely. Missing information could cause delays.
It may take up to an hour for your registration to be confirmed.
For questions about registration on the portal please seend email to HFS.Portalinquiries@illinois.gov