FAQs about IHC
Frequently Asked Questions about Illinois Health Connect  

Over 2,000 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.  

Q:  Can I wait to enroll?  

A:  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?  

A:  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.  

Q:  Can I still serve my patients without enrolling?  

A:  Not really.  Nearly all HFS 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.  

Q:  If I don’t enroll, can I still perform sick visits for All Kids patients?  

A:  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.   

Q:  How will my patients know to choose me as their PCP?  

A:  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.   

Q:  Will patients be auto-assigned to my practice?  

A:  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.    

Q:  How will I know who is assigned to me?  

A:  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.     

Q:  Will the referral system approve/reject referrals based on a review for “medical necessity”?  

A:  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.  

Q:  How is this different from Medicaid managed care?  

A:  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 providers.  Furthermore, 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 kjackson@iafp.com 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.

To enroll, please contact Automated Health Systems at 877-912-1999 or via e-mail at ILPCP@Automated-Health.com.  

* Some 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.