Date: August 6, 2018
To: Illinois Hospital Providers
Re: Standardized “Provider Roster” Template
This notice informs providers about the launch of a standardized “provider roster” format.
As part of an industry collaborative effort, the Department of Healthcare and Family Services (HFS), the Illinois Association of Medicaid Health Plans (IAMHP), Illinois participating Medicaid Managed Care Organizations (MCOs), and the Illinois Health and Hospital Association (IHA), are pleased to announce the launch of a standardized “provider roster” format.
Providers should utilize the standardized provider roster when submitting information to Medicaid MCOs as required for claims payment, care coordination and directory purposes. The collaborative efforts balance the needs of MCOs in collecting specific data not accessible through the HFS IMPACT verification system. Centers for Medicare & Medicaid Services (CMS) rules also require providers to utilize a more efficient process and singular provider roster format applicable to all Medicaid MCOs.
Important Points to Remember:
· Medicaid MCOs are no longer performing the “credentialing” function (i.e. primary source verification of provider backgrounds). The sole “credentialing” function occurs through the HFS IMPACT Enrollment system.
· The standardized roster format includes sections for individual provider information, group practice information, and facility information and addresses the need for information that impacts care coordination, claims payment, and provider directories.
o Additional tabs are included that provide specific data entry instructions and definitions of certain fields. These have also been standardized across MCOs so that the quality of data submitted to the MCOs is more accurate.
· Providers should note that the standardized roster format is only applicable to the Medicaid MCOs contracted with the Health Choice Illinois program. Other products, such as the Medicare/Medicaid Dual Alignment Initiative or commercial insurances, are not currently included in this standardization effort.
· Certain data elements required by the MCOs are now available on the IMPACT file which eliminates duplicate entry of information in both IMPACT and the provider roster. The IMPACT file is transmitted directly from HFS to the MCOs for loading in the payor system.
· Prior to the launch of the standardized format, all HFS contracted MCOs conducted testing of the revised layout to assure that the fields as formatted are compatible with MCO systems.
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.
Teresa T. Hursey