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Client Enrollment Auto-Assignment for ACEs and CCEs

General FHP/ACA Algorithm Process

The ICEB uses an algorithm to determine the best fit Plan and PCP for members who do not make an active Plan and PCP choice during their 60 day voluntary enrollment period. The algorithm considers the following factors to determine the best-fit Plan and PCP for an individual:

  1. The client�s current VMCO or MCCN Plan and PCP relationship.

  2. If the client is not enrolled with a VMCO or MCCN, their existing PCP relationship.

  3. The client�s claims history. This uses paid claims data provided by HFS, and identifies E&M claims and preventive medicine claims.

  4. Family members � particularly the Plan and PCP of the family member that is closest in age to the client.

  5. Geomapping � the residence address of the member, as a starting point to find closest available PCP.

  6. A random plan selection, when no other qualifying data points outlined above. Please contact with any questions.

Care Coordination

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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director