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). All providers are required to submit unresolved
disputes with an MCO to HFS via the secure, web-based Provider Resolution
portal. Issues that are submitted in the portal will be processed under the
provider dispute resolution process and applicable timeframes as required by
Public Act 101-0209 (SB1321) and in the Portal Tutorial and Overview documents provided
below. The goal of the portal is to encourage communication between the MCO and
Provider and to ensure fair resolution of disputes in an electronic and secure
format.
Please read before submitting a complaint
The
provider dispute resolution process requires providers to use the MCO internal dispute/appeal
process before submitting a complaint to HFS. This means
providers must first follow and exhaust ALL processes provided by MCOs
to resolve a dispute, including peer-to-peer before submitting a complaint
through the portal. Disputes submitted to the MCO internal
dispute resolution process may be submitted to the Provider Resolution Portal:
1) no sooner than 30 calendar days after submitting to the MCO's internal
process and 2.) no later than 60 calendar days after submitting to the MCO’s
internal process. If HFS determines a complaint was submitted sooner than
30 calendar days or later than 60 calendar 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 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. Tickets that are not complete when submitted, will be closed. Tickets
that are complete, will be submitted to the MCO for timely review and
response/resolution.
- 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 be directed 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 48 hours for your registration to be confirmed
For questions about registration on the portal please seend email to HFS.Portalinquiries@illinois.gov
Provider Resolution Portal Overview and Tutorial Documents:
Providers can click here, for access to the following Provider Resolution Portal materials:
Individual and Multiple Facility Registration Instructions
Multiple Facility Registration Template
Provider Portal Overview PowerPoint
Provider Portal Tutorial (Reviews the Portal Screens and Required Data Fields)
Multiple Complaints/Claims Excel Spreadsheet
MCO Provider Dispute Process and Tracking ID/Reference Number Summaries:
Providers can click
here, to get more information on each MCOs Provider Dispute Process and Tracking ID/Reference Number summaries.