Illinois Department of Healthcare and Family Services answers questions for ISDS Members!
In April, ISDS hosted the Annual Access to Care Conference. At the Conference, attendees had the ability to ask the Illinois Department of Healthcare and Family Services (IDHFS) questions. IDHFS took those questions and provided answers for us to share with all of our members.
Question: What steps has HFS taken to ensure MCOs provide accurate lists of providers, and what penalties are enacted if they do not do so in a timely manner?
Answer: HFS Provider enrollment continues to work diligently to provide the Managed Care Organizations (MCOs) with accurate provider listings. This is a work in progress due to having two different computer systems. HFS has provided a phone number and email in-box for customers to submit any mistakes in providers information 1-844-345-4654 or HFS.ProviderDirectory@illinois.gov.
Question: How can community organizations, advocates and case managers easily gain access to participating provider lists to help navigate the referral process? Access is often limited to patients or providers.
Answer: Provider Directories are required to be publicly accessible. See links below:
Blue Cross Blue Shield: https://www.bcbsi;.com/bcchp/getting-care/find-a-provider
County Care: https://countycare.valence.care/member/#findAProvider
An individual may also search provider directories that the MCOs have shared with the Client Enrollment Broker for enrollment education purposes at the following link: https://enrollhfs.illinois.gov/en/provider-search
Question: Can you explain the IMPACT process and why it takes so long to sign up? Also, can you please clarify the process for obtaining assistance with IMPACT sign up and how to get expedited assistance?
Answer: By gaining access to the IMPACT system, the Domain Administrator access cannot be granted for an enrollment application that is “In Review” status, the application must be approved.
For individual dentist enrollment, applications typically takes three weeks from the date of submittal to be reviewed and approved. A facility dental enrollment, can take longer due to the W9 certification process. The Comptroller’s Office deems these TIN/EINs as Disregarded Entities and requires a manual process for certification, which takes longer. Any provider enrolling in the IMPACT system must have the following before beginning an IMPACT Enrollment:
- Obtain an NPI.
- Ensure a Certified W9 is on file. Any provider who will be receiving state/federal funds from the Illinois Comptroller for services rendered must have a certified W9 on file with the State Comptroller.
- Ensure all professional licensures and certifications are current. Providers must maintain current licensure or certification as a condition of participation in the Medicaid Program.
Please see IMPACT Guide for additional help enrolling as a dental provider.
Note from ISDS: ISDS recently provided this guide to its members via email. Please let us know if you would like a copy of this guide.
Question: Is there something that could be done about the broken appointments? It makes scheduling very difficult.
Answer: HFS cannot charge Medicaid customers for missed or broken appointments.