SB 1697

Abstract

Amends the Medical Assistance Article of the Illinois Public Aid Code. Require managed care organizations (MCOs) to ensure (i) that contracted providers shall be paid for any medically necessary service rendered to any of the MCO's enrollees, regardless of inclusion on the MCO's published and publicly available roster of available providers; and (ii) that all contracted providers are contained on an updated roster within 7 days of entering into a contract with the MCO and that such roster be readily accessible by all medical assistance enrollees for purposes of selecting an approved healthcare provider. Requires the Department of Healthcare and Family Services to develop a single standard list of all additional clinical information that shall be considered essential information and may be requested from a hospital to adjudicate a claim. Provides that a provider shall not be required to submit additional information, justifying medical necessity, for a service which has previously received a service authorization by the MCO or its agent. Contains provisions concerning a timely payment interest penalty; an expedited provider payment schedule; a single list of standard codes to identify the reason for nonpayment on a claim; payments under the Department's fee-for-service system; a 90-day correction period for providers to correct errors or omissions in a payment claim; service authorization requests; discharge notification and facility placement; and other matters. Defines terms. Effective immediately.