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QCHP & QCDP Claim Payment Delay 

 

Updated: 11/21/2014

Notice Regarding QCHP and QCDP Claim Payment Delay

Specific questions or concerns regarding a claim payment?  Contact CMS Benefits Group Insurance at: CMS.WebsiteBenefits@illinois.gov.

The State of Illinois is facing a difficult and unprecedented funding situation which has significantly impacted the State Employees' Group Insurance Program through the delay of claim payments under the Quality Care Health Plan and the Quality Care Dental Plan. A brief explanation of the cause of the delay of claim payment for the Quality Care Health Plan and Quality Care Dental Plan is presented below.

Quality Care Health Plan

The State of Illinois' Quality Care Health Plan is a self-insured plan with funding provided through legislative appropriations, State revenue and a small amount of employee premiums. Funding availability is based on State revenue, which fluctuates from month to month. At this time funds remain insufficient to pay claims on a normal schedule, and we cannot estimate when a regular payment schedule will resume. Claim payments will be released according to the claim process date and available funding. CIGNA, the claims administrator, continues to process claims in a timely manner, but release of claims must be held until revenue is available. Late payment interest is paid to healthcare providers on health claims that take longer than 30 days from the receipt of a complete claim submission to pay. If you decide to make arrangements with your out-of-network provider to pay the outstanding balance or establish a payment plan, your provider should reimburse you after they receive payment from CIGNA. It is your responsibility to make reimbursement arrangements with your provider.

Claims processed through 02/14/2014 have been released to QCHP-contracted providers.
Claims processed through 11/29/2013 have been released to non-QCHP-contracted providers.

This information will be updated when the release date changes.

Quality Care Dental Plan

The State of Illinois’ Quality Care Dental Plan (QCDP) is a self-insured plan with funding provided through legislative appropriations, State revenue and a small amount of employee premiums. Members may seek treatment from any dentist and claim payment is based on a dental Schedule of Benefits. Only dental codes listed on the Schedule of Benefits are covered under the QCDP. Funding availability is based on State revenue, which fluctuates from month to month. At this time funds remain insufficient to pay claims on a normal schedule. Claim payments will be released according to the claim process date and available funding. Late payment interest is paid to dental providers on dental claims that take longer than 30 days from the receipt of a complete claim submission to pay. If you decide to make arrangements with your provider to pay the outstanding balance, or establish a payment plan, your provider should reimburse you after they receive payment from Delta Dental. It is your responsibility to make reimbursement arrangements with your provider.


Dental claims under Delta Dental are being processed based on whether they were incurred at a network or non-network dentist.  Please see the payment release schedule on Delta Dental's website for information.

This information will be updated when the release date changes.

Originally Posted: 10/01/2009