Information provided by HFS in a recent notice re: credentialing

Helping Families. Supporting Communities. Empowering Individuals.

Please see the attached information provided by HFS in a recent notice re: credentialing. Also attached at the bottom of this email is the link that can provide more information as needed.

This is the third 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.

Simplified Credentialing for all Plans

Among the major upgrades of HealthChoice Illinois for providers will be single and simplified credentialing. Under the new program, registering with the Department's online provider enrollment program will become the only requirement to begin developing relationships with every Medicaid managed care health plan.

Currently, providers must expend resources becoming credentialed with each plan before they can contract with them. This cumbersome process has discouraged participation and added an unnecessary burden on providers.

Under HealthChoice Illinois, Medicaid providers will need to only register with HFS IMPACT website (Illinois Medicaid Program Advanced Cloud Technology). Once an application is approved by HFS, the provider is considered credentialed with the Health Plan. Plans will not be allowed to require any additional credentialing.

Please be aware of two important features of this upgrade. First, the change applies only to Medicaid, not Medicare or other products. Second, although providers will be credentialed through IMPACT, they should continue to provide specific information requested by MCOs that is not included in the credentialing process but is needed for MCO Operations, such as provider office hours.

Understanding More

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 (Benefits notice)

#3. Simplified credentialing: Cutting back on your overhead

#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

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn171030d.aspx