January 31, 2017

New Provider Complaint Portal Launched for Medicaid Managed Care

By Melissa Korey, Supervisor, Advisory Services

New Provider Complaint Portal Launched for Medicaid Managed Care

Last week, the Illinois Department of Healthcare and Family Services (HFS) launched a provider complaint portal to help providers resolve outstanding issues with individual Medicaid Managed Care Organizations (MCOs). The State’s goal behind the new secure portal is to allow fair resolution between providers and MCOs within a reasonable timeframe (2-15 business days).

HFS has indicated that providers must still continue to work with MCOs and follow their internal resolution process prior to utilizing the HFS compliant portal. If the State receives a case in which a provider did not attempt to work the MCO, then the compliant will be omitted. In addition, if providers have issues with multiple MCOs, they will need to complete a form for each individual MCO.

For instances where the complaint relates to a specific member, the provider will need to report the member’s first and last name, there Recipient Identification Number (RIN), and the date of service that the issue correspondence to. If there are several dates of service affected by the complaint, HFS has requested that a spreadsheet detailing this information be uploaded in the attachments section of the form.

Providers should be aware that the provider contact name used on the compliant form will be shared with the MCO and the State will only report the outcome of the complaint to that individual.

HFS intends to collect and public report the compliant information received by provider type and MCO. This will help the State identify major issues with the Medicaid managed care program and propose applicable resolution either through public notice or legislation.

To access the provider complaint portal, please visit the HFS website.

If you have any questions regarding the use of the portal or Illinois’ Medicaid managed care programs, please contact your Marcum LLP advisor at 847-282-6300.

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