Date: October 26, 2017
To: All Medical Assistance Providers
Re: Succeeding in the New Managed Care Program Series (#2): Four key ways the new managed care will mean less work for providers
This is the second in a series of notices to help providers succeed with the upcoming enhancement of the Managed Care Program at the Department of Healthcare and Family Services (HFS).
The new Managed Care Program is named “HealthChoice Illinois.”
Beginning on January 1, 2018, newly selected health plans under HealthChoice Illinois will have a contract to begin managing Medicaid client care in every Illinois County (Overview Notice), phased-in according to the program expansion mail schedule. Upgrades built into the program will also help providers participate more easily.
Simpler and More Efficient
When mandatory managed care began in Illinois in 2014, the Department focused largely on transitioning Medicaid clients into the new program. In the time following, HFS has listened closely to provider concerns and suggestions.
HealthChoice Illinois will reduce the number of health plans in the program. HFS believes with an ideal number of health plans operating at the appropriate size, providers and clients will be better served.
Four specific enhancements for providers that are being implemented:
· Simplified and single credentialing will eliminate the need to be separately credentialed by every health plan before contracting with them. Under the rebooted program, as soon as providers are approved by IMPACT – the HFS Provider Enrollment System – they will be cleared to contract with every health plan without additional credentialing requirements.
· Intense readiness reviews to make sure health plans are prepared for their responsibilities, giving providers more assurance that plans can meet the requirements of the program.
· An online health-plan-specific quality report card to help clients make smart health plan choices.
· The new Integrated Eligibility System (IES) means clients can better access their own eligibility and health plan enrollment information for less confusion among your patients.
The reboot of managed care has already created the provider complaint portal to help resolve difficulties that cannot be addressed through the health plan process.
Upcoming notices in this series will explain credentialing and the single PDL in more detail. HFS will also provide additional information on IES and other benefits of HealthChoice Illinois.
Articles in the Department’s Succeeding in the New Managed Care series:
#1. What is my relationship with health plans that weren’t awarded a contract for the new program? (Exiting Health Plans Notice)
#2. Four key ways the new managed care will mean less work for providers
#3. Simplified credentialing: Cutting back on your overhead costs
#4. How HFS and the health plans will communicate transition details to clients
#5. How you can help your patients understand what they need to know about this transition
Additional information regarding HealthChoice Illinois may be found on Department Website
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.
Felicia F. Norwood