Managed Care Organizations

Managed Care Organizations

October 9, 2014

Communication Alert:  Regional Executive Directors and Regional Contract Managers:

Please distribute the following communication alert. Thanks.


 

Dear DMH Provider:

Subsequent to a meeting held by the Department of Healthcare and Family Services (HFS) bringing together providers from Region 1 & 2 and all Managed Care Organizations (MCOs) serving those regions, HFS has prepared the attached spreadsheet which provides key contacts for all Medicaid MCOs operating in Illinois. This spreadsheet indicates the "go-to" person at each MCO for questions about contracting, and the "go-to" person for issues related to the provision of the actual behavioral health services, such as authorizations and claims submissions.

HFS has also posted an updated version of the Illinois map which shows the MCOs operating across Illinois. The link for this map is:

http://www2.illinois.gov/hfs/SiteCollectionDocuments/CCExpansionMap.pdf

Contact Brenda Cunningham if an accessible document is needed.
Thank You,

DMH Community Services 



Managed Care Organizations - Contacts for BH Providers - October 2014

Managed Care Organizations Question Type Contact Person(s)

Contact numbers, addresses

and e-mails 

1 Aetna Better Health

Contracting and

Behavioral Health

Terriana Clark - primary

Network Account Manager

3200 Highland Ave. FLR. #3

Downers Grove, IL 60515

630-737-6462 Telephone

331- 481-2256 Mobile

Clarkt9@aetna.com

Brenda Brown - backup

Network Account Manager

One South Wacker Drive, Suite 1200 MCF646

312-821-0582 Telephone

312-339-8942 Mobile

BrownB7@aetna.com

2 Blue Cross Blue Shield Contracting

Asha B. Maghirang (Contracting)

Manager, Medicaid Provider Network

Behavioral Health and Long Term Support and Services

312-653-2379

Asha_maghirang@bcbsil.com

Behavioral Health

Nicole Lee

Senior Manager BH Clinical Operations, Government Programs

300 East Randolph Street
Chicago, IL 60601-5099

312-653-5047 (office)

773-405-0719 (cell)

Nicole_Lee@bcbsil.com 

Brandon Meister

Enterprise Health Care Management

Consultant Behavioral Health, Government Programs

300 East Randolph Street
Chicago, IL 60601-5099

312-653-3842 (office)

brandon_meister@bcbsil.com

3 CIGNA HealthSpring Contracting Andrew Galbierz, Manager of Contracting

312-548-2015

andrew.galbierz@healthspring.com 

Behavioral Health Heather L. Baroni, Vice President of Health Services

615-565-8110

Extension 508871

heather.baroni@healthspring.com

4 Community Care Alliance of Illinois (CCAI) AND 5 Family Health Network (FHN)

CCAI and FHN subcontracts with PsycHealth for their behavioral health services

Contracting Cathryn Shemroske, Manager

847-864-4961 extension 3303

providerservices@psychealthltd.com

Behavioral Health

Reena Lopez, supervisor


Dr. Nora Mariduena, Director of Clinical Operations

847-864-4961 extension 3326 ClinicalCare@psychealthltd.com

847-864-4961 extension 3308

ClinicalCare@psychealthltd.com

6 County Care AND 7 IlliniCare Health Plan (Centene)

County Care & IlliniCare Health Plan subcontract with Cenpatico for their behavioral health services.

Contracting

Elisa Castro

Provider Relations Specialist

Network Operations

866.329.4701 x47608 office

ELCASTRO@cenpatico.com

Andrea Potter

Provider Relations Specialist

Network Operations

866.329.4701 x 47853 office

APOTTER@centene.com

Behavioral Health

Alicia Searcy, MBA

Manager, Network Development

Network Operations

866.329.4701 x 47829 office

ASEARCY@cenpatico.com

8 Harmony Health Plan Contracting Demetrius Gordon

312-516-5852

demetrius.gordon@wellcare.com 

Behavioral Health

First option: Provider Services

Second option: Michelle Wilson

1-800-608-8158

312-516-5890

michelle.wilson@wellcare.com 

9 Health Alliance Medical Plan Contracting Maxine Wallner

301 South Vine Street

Urbana, Illinois 61801-3347


217-337-8117

Maxine.Wallner@healthalliance.org

Behavioral Health Kathy Hershberger

301 South Vine Street

Urbana, Illinois 61801-3347


217-255-4588

Kathy.Hershberger@healthalliance.org

10 Humana Health Plan

Humana subcontracts with Beacon Health Strategies for their behavioral health services.

Beacon Provider Inquiries 1-855-481-7044 *Use this # to call re: member eligibility, authorizations and plan questions
Beacon Contracted Provider Contact Lisa Cook - Manager of Provider Partnerships 630-382-5258 *specifically for plan operation issues
Beacon Network Contact Gary Wagner - Network Manager 630-382-5262 *specifically for provider contracting & credentialing
11 Meridian Health Plan
 Contracting

Kimberly Gallagher

Provider Network Development Representative

333 South Wabash Avenue, Suite 2900

Chicago, IL 60604

phone: 312-705-2900, ext. 2169

cell: 217-480-5621

kimberly.gallagher@mhplan.com 

Behavioral Health

Colleen Dore

Manager of Behavioral Health

333 South Wabash Avenue, Suite 2900

Chicago, IL 60604

phone: 312-980-2361

cell: 312-835-1610

colleen.dore@mhplan.com 

12 Molina HealthCare Contracting Michael Manade

630-200-8504

michael.manade@molinahealthcare.com

Behavioral Health Provider Services

Cook County Provider Contact: Gary Colucci

Central Illinois/Metro East Provider Contact: Jared Fritz

479-653-4832

Gary.Colucci@molinahealthcare.com

217-260-7674

Jared.Fritz@molinahealthcare.com

Katie Jones - BH Director

1-888-562-5442, extension 165454

Kathleen.jones@molinahealthcare.com