HFS recognizes the importance of providers having an outlet for
reporting issues they may be having with an Illinois Medicaid Managed Care
Health Plan (MCO). All providers are required to submit unresolved
disputes with an MCO to HFS via the secure, web-based Provider Resolution
portal. Issues that are submitted in the portal will be processed under the
provider dispute resolution process and applicable timeframes as required by
Public Act 101-0209 (SB1321) and in the Portal Tutorial and Overview documents provided
below. The goal of the portal is to encourage communication between the MCO and
Provider and to ensure fair resolution of disputes in an electronic and secure
format.
Please read before submitting a complaint
The
provider dispute resolution process requires providers to use the MCO internal dispute/appeal
process before submitting a complaint to HFS. This means
providers must first follow and exhaust ALL processes provided by MCOs
to resolve a dispute, including peer-to-peer before submitting a complaint
through the portal. Disputes submitted to the MCO internal
dispute resolution process may be submitted to the Provider Resolution Portal:
1) no sooner than 30 calendar days after submitting to the MCO's internal
process and 2.) no later than 60 calendar days after submitting to the MCO’s
internal process. If HFS determines a complaint was submitted sooner than
30 calendar days or later than 60 calendar days after submitting the dispute to
the MCO’s internal process, the complaint will be immediately closed. Under
the MCO internal dispute process, MCOs are required to assign the provider a tracking
number for each complaint submitted. The provider must enter this MCO assigned
tracking number in the Provider Resolution portal when completing a complaint
ticket. Tickets that are not complete when submitted, will be closed. Tickets
that are complete, will be submitted to the MCO for timely review and
response/resolution.
Providers must use the new standard Complaints/Claim-Issue template for submitting two (2) or more of the same or similar complaints/claims with the same MCO. Providers are limited to a maximum of 100 complaints/claims on a template.
Please use the template provided here. - A complaint ticket must be filled out completely or it will be closed. Closed tickets will not be reopened or restarted. A new ticket will need to be submitted in the Portal.
- Providers and MCOs are expected to also follow Health Insurance Portability and Accountability Act of 1996 (HIPAA) procedures when submitting and sharing data via the portal.
- Provider complaints regarding the resolution of Medicaid fee-for-service issues should continue to be directed to HFS at 877-782-5565.
- All providers or designated billing staff/agents will be required to set up an account to register with the portal in order to access and submit disputes.
To Register or Sign On click the Login button below or click this link
Individual and Multiple Provider/Facility Registration Instructions
To Register: Enter your e-mail, choose a Username and Password, and click Register
If a provider or representative is registering for multiple providers or facilities, they must use the multiple registration template provided here
On the Registration form, fill out all fields completely. Missing information could cause delays
If a provider is not registered to use the Portal, the provider will not be able to enter a ticket
Please allow a minimum of 2 business days for the registration process to be completed.
Incomplete registration requests will be denied, and the provider will not be able to enter a ticket until the missing or incomplete information has been provided.
For questions about registration on the portal please send an e-mail to HFS.Portalinquiries@illinois.gov
Provider Resolution Portal Overview and Tutorial Documents:
