Illinois enacts Medicaid overhaul aimed at transparency, decreasing claim denials

Illinois enacted a Medicaid revamp Aug. 5 that aims to reduce barriers to healthcare access, decrease claim denials and improve transparency, Gov. JB Pritzker announced.

The overhaul is part of new state legislation. According to the governor's office, the bill will:

  • Enable the Illinois Department of Healthcare and Family Services to create a resolution process to resolve payment disputes between providers and managed care organizations.
  • Set a 30-day deadline for managed care organizations to pay long-term care facilities, safety-net hospitals and other healthcare providers that serve a large number of Medicaid enrollees.
  • Enable the Illinois Department of Healthcare and Family Services to set up a new claims clearinghouse for claims from providers to managed care organizations.
  • Require a full review of the process through which Medicaid patients report income information "to identify changes that will allow more patients to be renewed automatically and ensure patients are maintaining the highest continuum of care possible."

Read more about the Illinois law here.


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