bcbs medicaid illinois Overview of Medicaid Programs and Administration

In Illinois, Medicaid is a vital program that provides health coverage to low-income individuals and families.

The Illinois Medicaid program is administered by the Illinois Department of Healthcare and Family Services.

There are several types of Medicaid programs in Illinois, including the Illinois Medicaid program for pregnant women, children, and families.

The Illinois Medicaid program for pregnant women provides comprehensive prenatal care, delivery, and postpartum care.

Broaden your view: What Insurances Are Medicaid

HealthChoice Illinois is a program that provides comprehensive health coverage to eligible individuals, including families and children, adults under the Affordable Care Act, seniors, and adults with disabilities. It's a vital resource for many people in Illinois.

In FY 2022, HealthChoice Illinois (HCI) worked with five managed care plans to serve its population. These plans were carefully selected for their experience, financial stability, and ability to provide quality care.

The HCI program covers a wide range of benefits, including medical, dental, and vision care. It also provides some mental health and transportation services, but those are limited to the MLTSS population.

Explore further: Bcbs Behavioral Health

The MLTSS population receives some long-term services and supports, along with mental health and transportation services, from their HCI health plan. All other services for MLTSS customers are covered by Medicare and Medicaid fee-for-service.

Here's a breakdown of the HCI population served by the managed care plans:

In Illinois, there are Medicaid programs designed to provide health insurance to those who need it most. The state's Department of Children and Family Services (DCFS) has a specialized health plan called HealthChoice Illinois - YouthCare.

YouthCare offers trauma-informed care coordination for behavioral health needs, and provides specialized programming for adoptive families. DCFS youth also receive additional benefits through this plan.

Youth in care, which includes those living with foster parents or in group homes, are eligible for these services.

Illinois operates three distinct care coordination programs within the broader Illinois Medicaid Managed Care program: HealthChoice Illinois (HCI), YouthCare, and the Medicare Medicaid Alignment Initiative (MMAI).

Related reading: Bcbs Medicaid Provider Finder

The Department of Healthcare and Family Services (HFS) manages these programs to provide comprehensive care to Medicaid recipients.

CountyCare Health Plan is a care coordination program available only in Cook County. You can visit their website at www.countycare.com or call them at 1-855-444-1661.

The Illinois Department of Healthcare and Family Services (HFS) oversees the state's managed care programs, which aim to provide accessible and quality care to Medicaid recipients.

Blue Cross and Blue Shield of Illinois has been sanctioned by the state for not meeting access standards for its Medicaid managed care network. This includes not automatically enrolling members into Blue Cross plans and not allowing newly enrolled members into those plans.

The state requires Medicaid payers to provide a level of access for doctors, hospitals, and specialists. This includes making sure members have access to a nearby provider and get seen within a certain amount of time.

Here are the three distinct care coordination programs offered by the Department of Healthcare and Family Services (HFS):

Behavioral Health (Medicaid) in Illinois is a crucial aspect of the state's Medicaid programs. Behavioral Health services are available through the BCCHP and MMAI programs.

If you're looking to access Behavioral Health services, you'll need to submit a specific form, depending on the type of service you require. For Applied Behavior Analysis, you'll need to fill out the Applied Behavior Analysis - Clinical Service Request Form or the Applied Behavior Analysis - Initial Assessment Request Form.

Medicaid only covers these services, so make sure you're enrolled in a Medicaid program. Community Based BH Request Forms are also available for those seeking community-based Behavioral Health services.

If you need to request Electroconvulsive Therapy (ECT), you'll need to submit a Fax Coversheet, which is also Medicaid only. Psychological/Neuropsychological Testing can be requested through the Psychological/Neuropsychological Testing Request Form.

Transcranial Magnetic Stimulation (rTMS) services can also be requested through the Transcranial Magnetic Stimulation (rTMS) Request Form, both of which are Medicaid only.

Here is a list of the forms you may need to access Behavioral Health services through Medicaid:

In Illinois, the HealthChoice Illinois (HCI) program is administered by the Illinois Department of Healthcare and Family Services (HFS). HFS holds contracts with five qualified Managed Care plans to serve the HCI population.

These plans cover a wide range of benefits, including healthcare services for families and children, adults eligible for Medicaid under the Affordable Care Act, seniors, and adults with disabilities who are not eligible for Medicare. They also cover special needs children, including Former Youth in Care and Youth in Care.

Here are some of the populations served by the HCI program:

When dealing with claims, it's essential to know the fastest way to conduct business with BCBSIL, which is through Electronic Data Interchange (EDI).

This method allows for a seamless claims process, and you can learn more about it in the Claim Submission section.

Government Programs claims must be submitted within 180 days of the date of service and/or discharge date.

A unique perspective: Bcbs Claim Mailing Address

In Illinois, the administration of Medicaid requires certain training for providers, and BCBSIL has made these resources available.

BCBSIL provides training on specified topics related to BCCHP and MMAI, which is a requirement by the CMS and/or State of Illinois.

To get started with the training, you can visit the BCCHP Provider Finder, which is a great resource to find training materials and other useful information.

BCBSIL also offers a Provider Flyer that provides an overview of the training requirements and resources available.

If you're looking for more specific information on utilization management, prior authorization, and clinical review, you can refer to the BCCHP Utilization Management, Prior Authorization and Clinical Review Tip Sheet.

Here are some additional resources that may be helpful:

Credentialing is a crucial step in getting approved to provide services to Illinois Medicaid patients.

To start the credentialing process, you'll need to submit an Attestation for Provider Credentialing form, which applies to providers in Commercial, MA HMO, MA PPO, and MMAI networks.

For another approach, see: Bcbs Credentialing Application

If you're a hospital, you'll also need to submit a Hospital Coverage Letter, although updates are currently in progress.

If you're looking to provide Durable Medical Equipment (DME) to Medicaid patients, you'll need to fill out a DME Benefit Limits Verification Request Form, which is specific to Medicaid-only networks like BCCHP and MMAI.

Curious to learn more? Check out: Beltone Accept Medicaid

HealthChoice Illinois (HCI) is a program that brings together managed care plans to provide healthcare services to eligible populations. In FY 2022, there were five managed care plans serving the HCI population.

These plans cover families and children, adults eligible for Medicaid under the Affordable Care Act, seniors and adults with disabilities who are not eligible for Medicare, and dual Medicare-Medicaid eligible adults receiving certain Long Term Services and Supports (LTSS). Special needs children, including Former Youth in Care and Youth in Care, are also covered.

The Managed Care map provides more information about the MCOs operating in the HCI program.

For customers with Long Term Services and Supports (MLTSS), their HCI health plan covers some long term services and supports, along with some mental health and transportation services. All other services for MLTSS customers are covered by Medicare and Medicaid fee for service.

For another approach, see: Bcbs Short Term

Illinois is taking action against Blue Cross and Blue Shield of Illinois for not meeting access standards for its Medicaid managed care network.

The state has sanctioned the payer, which means they're facing penalties and fines. For example, Blue Cross won't automatically enroll members into their plans, and new members can't join immediately.

The state requires Medicaid payers to provide a certain level of access to doctors, hospitals, and specialists. This includes ensuring members have access to a nearby provider and receive timely care.

The Illinois Department of Healthcare and Family Services has fined Blue Cross $150,000 as a result of these issues.