HFSHealthChoice Illinois

Provider FAQs

What is HealthChoice Illinois managed care?

HealthChoice Illinois is the state’s rebooted managed care program that began rolling out in January 1, 2018. The program provides enhanced quality and improved outcomes, with special upgrades designed to help providers.

Who is eligible and who is not included in HealthChoice Illinois managed care?

Medicaid members who previously participated in the mandatory managed care program are included in the new HealthChoice Illinois, in addition to special needs children, children receiving SSI, children in the Medically Fragile Technology Dependent waiver, and DCFS youth. HealthChoice Illinois also expanded managed care to every county in Illinois.

How do I become a participating provider and contract with the managed care plans?

New providers should credential through IMPACT. Providers will also need to contract with each plan individually by contacting the plans’ provider services.

Who do I contact for billing questions?

Billing questions should be directed toward the plan that the member is enrolled with.

How do I check eligibility for a client and what plan is my patient enrolled in?

Providers should check eligibility by utilizing the Medical Electronic Data Interchange (MEDI).

What about youth in DCFS care?

Managed care is to be provided by IlliniCare Health to youth in DCFS care starting in 2018.

What if a member is transitioning between different managed care organizations (MCOs) or between managed care and FFS (fee for service), whether due to eligibility changes or a change in MCO enrollment and is in the middle of a treatment?

Health plans must offer an initial 90–day transition period for members new to the plan, in which members may maintain a current course of treatment with a provider who is currently not a part of the plan’s network. The 90–day transition period is applicable to all providers, including Behavioral Health Providers and Providers of LTSS. Plans are to pay for covered services rendered by a non-network provider during the transition period at the same rate the Department would pay for such services under the Illinois Medicaid FFS methodology. Non-network providers and specialists providing an ongoing course of treatment will be offered agreements to continue to care for an individual member on a case-by-case basis beyond the transition period if the member remains outside the network or until a qualified network provider is available.

What is the Client Enrollment Broker?

The Illinois Client Enrollment Broker (CEB) provides unbiased education and enrollment assistance to potential enrollees, as well as performs plan switches for those already enrolled. The CEB is open Monday to Friday, 8am-7pm, and the toll-free number is: 1(877)912-8880 (TTY 1-866-565-8676). The CEB program website offers more information about the managed care programs, plan choices by region, how to get more information or assistance with making a plan choice. It can be accessed at: https://enrollhfs.illinois.gov/ .

How does HealthChoice Illinois affect the Medicare-Medicaid Alignment Initiative (MMAI) Program?

The MMAI program continues to operate under a separate three-way contract between HFS, the federal Centers for Medicare & Medicaid Services (CMS), and health plans. The program did not expand to additional counties in 2018. The following health plans continue operating in MMAI in 2018: Aetna Better Health, Blue Cross Blue Shield of Illinois, Humana Health Plan, IlliniCare Health, Meridian Health, and Molina Healthcare of Illinois.

More information: https://www.illinois.gov/hfs/MedicalProviders/cc/Pages/HealthChoiceFAQ.aspx

 


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