HFSMedical ProvidersCare Coordination

Managed Care Provider Resolution Portal

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 must use the new standard Complaints/Claim-Issue template for submitting two (2) or more of the same or similar complaints/claims with the same MCO. Providers are limited to a maximum of 100 complaints/claims on a template. Please use the template provided here

  • A complaint ticket must be filled out completely or it will be closed.
 
  • 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.

 

 
 
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