New Resource Takes Aim at Illinois Medicaid MCO Denials

medicaid puzzle pieceIf you’ve struggled with claim denials from Illinois’ Medicaid managed care system, help is on the way.

The Illinois Association of Medicaid Health Plans (IAMHP), which represents the six Medicaid managed care insurers operating in the state, has developed a new manual in partnership with the Illinois Department of Healthcare & Family Services (DHFS) to standardize claims- and billing-related policies and procedures.

You can find that resource here.

Last month, Illinois lawmakers introduced several bills aimed at the state’s Medicaid managed care program, including some demanding more uniform rules to prevent denials of claims due to process and paperwork rather than medical reasons. They include S.B. 1697, which would require insurers to standardize medical-necessity documentation and service authorization, and S.B. 1807, which aims for accurate, on-time reimbursement – whether or not insurers’ provider rosters are up-to-date.

Follow ISMIE News for further updates on this important practice issue.