Frequently Asked Questions about Illinois Health Connect
providers have agreed to participate in Illinois Health connect in
the last few months! IAFP
leaders are educating family physicians statewide about Illinois
Health Connect by phone and through presentations at hospitals and
practices. Here are some
of the most common questions we’ve heard to date.
Can I wait to enroll?
No, you shouldn’t. Client
enrollment in the primary care case management (PCCM) program will
be phased in by county. Patients
in Cook and the collar counties (DuPage, Grundy, Kane, Kankakee,
Kendall, Lake, McHenry, and Will) will be enrolled and choose a PCPs
in January 2007. Patients
in northwestern Illinois (24 counties including Peoria and
Winnebago) and central/southern Illinois patients will enroll and
choose a PCP in the following months.
If you are not enrolled, patients will not be able to choose
your practice or be assigned to you.
Your current patients may not be able to continue to see you.
Q: I’m already a
Medicaid provider and also enrolled in the Maternal and Child Health
(MCH) program. Do I need to enroll in IHC?
Yes. You need to
enroll in the PCCM program as well in order for Illinois Health
Connect to assign patients to you. The PCCM application requests
some information similar to what you provided on your Medicaid or
MCH application, but it also requests important information about
how many patients you are willing to have in your practice, other
providers in your practice who will be able to serve your patients
in your absence, and more.
Can I still serve my patients without enrolling?
Not really. Nearly
medical assistance (Medicaid)
patients* will participate in Illinois Health Connect and choose or
be assigned to one PCP. If
you are not enrolled, you will not be assigned patients.
Claims for services you provide to patients assigned to other
PCPs will not be paid unless you have a referral from the PCP.
And enrollment guarantees you will receive the enhanced
payment rates for common patient visits.
If I don’t enroll, can I still perform sick visits for All
No, providers who do not enroll in Illinois Health Connect
will generally not be able provide any primary care services,
including both well and sick visits.
The only providers who will get paid for any sick or well
visits without enrolling would be serving a patient in one of the
groups “excluded from participation” in the PCCM program* or
working in “direct access” sites such as emergency rooms or
school-based clinics. All
other All Kids patients will be enrolled, and must get their primary
care services from their assigned PCP or have a referral from the
PCP to get care somewhere else.
How will my patients know to choose me as their PCP?
Start educating them now about what a “medical home” is
and encourage them to list you as their primary care provider when
contacted by Illinois Health Connect.
Will patients be auto-assigned to my practice?
Patients who do not choose a PCP will be auto-assigned to a
PCP based on their previous claims history, location and care
patterns. If you
request to participate in auto-assignment on your IHC application,
patients who do not choose a PCP can be assigned to your practice.
You can also specify if you want auto-assignment of existing
patients, newborns or family members of existing patients.
You can tell IHC how many patients you want to serve, specify
ages or genders, and more.
How will I know who is assigned to me?
Each PCP will receive a monthly client roster for all clients
enrolled with that PCP. PCPs
should still verify enrollees’ eligibility via the Automated Voice
Response System (AVRS) at 800/842-1461, the MEDI system online at http://www.myhfs.illinois.gov
or the Recipient Eligibility Verification (REV) system at http://www.hfs.illinois.gov/rev
AVRS and REV are available 24/7.
Will the referral system approve/reject referrals based on a
review for “medical necessity”?
No. The referral system will not review for medical
necessity. Nor will it
approve/reject a referral for any reason. The purpose is for logging
and tracking referrals.
How is this different from Medicaid managed care?
Illinois Health Connect is a hybrid between fee-for-service
and managed care, with PCP assignments but fee-for service payment
(plus the per patient/per month payment) for private practice
referrals are not reviewed for medical necessity as they are in many
managed care plans. Voluntary
managed care programs will continue to be
an option in certain counties (Cook, Madison, Perry, Randolph, St.
Clair and Washington) and Medicaid recipients will be offered a
choice between those managed care plans and Illinois Health Connect.
Automated Health Systems is the vendor hired to manage
Illinois Health Connect, and AHS is not affiliated with any managed
care plan/organization, directly or indirectly.
For more information, visit IAFP’s web site at http://www.iafp.com
or contact the IAFP office at 630-435-0356, ext 221 or firstname.lastname@example.org
with your own questions or concerns.
You can also contact IHC’s Provider Helpline at
1-877-912-1999 or visit their website at http://www.IllinoisHealthConnect.com.
please contact Automated Health Systems at 877-912-1999
e-mail at ILPCP@Automated-Health.com.
patients will be excluded from participation in the PCCM program,
including children with SSI, children in foster care, and others.
For a complete list of excluded groups, see http://www.illinoishealthconnect.com.