ALERT: Providers Contracting with HealthChoice Illinois Plans
||All Medical Assistance Program Providers|
||December 15, 2017|
||ALERT: Providers Contracting with HealthChoice Illinois Plans|
Providers serving Medicaid patients are strongly encouraged to contract with HealthChoice Illinois plans now, in order to participate in the statewide managed care program in 2018. This will ensure that providers will be able to care for their Medicaid patients in the counties about to become part of HealthChoice Illinois.
HealthChoice Illinois - Statewide Managed Care Program
The Department of Healthcare and Family Services (HFS) listened to input from providers and other stakeholders in creating HealthChoice Illinois. The statewide program reduces the number of plans in the program to better serve patients and providers. In addition, simplified and single credentialing will eliminate the need for providers to be separately credentialed by every health plan before contracting with plans. Please see Provider Communication dated October 26, 2017.
The following plans are participating in the HealthChoice Illinois program:
• Blue Cross Blue Shield of Illinois (Statewide)
• CountyCare (available only in Cook County)
• Harmony Health Plan (Statewide)
• IlliniCare Health Plan (Statewide)
• Meridian Health (Statewide)
• Molina Healthcare of Illinois (Statewide)
• NextLevel Health (available only in Cook County)
Contracting with Participating HealthChoice Illinois Plans
Plans are in the process of expanding provider networks across the State and are reaching out to providers. However, providers can and should contact plans directly to begin the contracting process. Contact information for participating plans is provided in Attachment A. For a map showing where plans are operating, visit the updated HealthChoice Illinois program map.
It is imperative that providers of all types (specialists, hospitals, etc.) join managed care networks in order to ensure timely payment and continued access to care for their current patients. Before contracting with any plans, providers must also make sure they are enrolled in the Department’s IMPACT system. Once providers are enrolled in IMPACT and contracted with plans, they may provide services to patients enrolled in that plan.
It is important that providers check a patient’s eligibility on the date of service to confirm the patient’s plan enrollment, even if the enrollment had previously been verified. The Recipient Eligibility Verification (REV) System, the Automated Voice Response System (AVRS), and the Medical Electronic Data Interchange (MEDI) system will identify the plan in which the beneficiary is enrolled.
Illinois Health Connect Program Ending – Primary Care Providers (PCPs) Urged to Contract with Plans
Under expansion of the Managed Care Program, the Illinois Health Connect (IHC) Program will no longer be a plan option for patients as of the end of this year. Patients currently enrolled with a PCP in this program will begin to pick HealthChoice Illinois plans and PCPs for care coordination the week of January 8, 2018, for the April 1, 2018 enrollment effective date. IHC PCPs currently serving IHC patients should begin the process of contracting with the HealthChoice Illinois plans now, so they are available as a PCP choice for their patients in the new program.
HealthChoice Illinois - Transition and Expansion Updates
Once expansion of the statewide managed care program has been completed, it is expected that 80% of all Medicaid beneficiaries will receive care through HealthChoice Illinois plans. For providers, this means the greatest opportunity to participate with the Medicaid program will be through the HealthChoice Illinois program and the participating Managed Care Organization plans, with fewer patients accessing services through traditional Medicaid fee-for-service. Individuals transitioning into HealthChoice Illinois early next year will only be able to see providers who have become part of a HealthChoice Illinois plan.
Patients living in one of the 30 counties currently with mandatory managed care programs have begun receiving HealthChoice Illinois transition notices educating them on the statewide program and plan options to become effective January 1, 2018. For patients in expansion counties (72 counties where managed care is not currently a mandatory program), HealthChoice Illinois enrollment packets will begin to be mailed the week of January 8, 2018, for the earliest program enrollment effective date of April 1, 2018. The enrollment packets provide each individual with information about plan choices, enrollment period, participating providers in each plan’s network, and choosing a plan and PCP. To ensure that a provider’s patients can select them for their PCP in the expanded program, and those providers can continue to serve their patients without disruptions; providers need to join the HealthChoice Illinois plans’ networks now. The current HealthChoice Illinois transition and expansion mail schedule can be found here
The Department strongly encourages providers to begin contracting with HealthChoice Illinois plans now, in order to participate in the statewide managed care program in 2018.
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.
Felicia F. Norwood