summary
Introduced
02/02/2026
02/02/2026
In Committee
02/10/2026
02/10/2026
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to adopt rules that require managed care organizations (MCOs) to utilize a universal provider application developed by a council for affordable quality healthcare, as defined, for the purpose of credentialing a health care professional or a health care provider who seeks to participate in an MCO's provider network. Provides that the rules may also require the use of a CAQH application for the renewal of credentials; and that the Department may revise the CAQH universal provider application or the application for renewal of credentials to conform to industry or national standards for credentialing health care professionals or health care providers. Provides that within 180 days after the adoption of rules, health and dental plan carriers must accept the universal provider application and the application for the renewal of credentials approved by the Department. Requires all MCOs to provide a provider network consultant to act as a liaison between a health care provider and the MCO. Require the Department to employ provider enrollment consultants to assist health care providers with enrollment in the Illinois Medicaid Program Advanced Cloud Technology system, help navigate the enrollment and provider credentialing process by serving as the liaison between health care providers and MCOs, and other matters. Amends the Illinois Insurance Code. In provisions concerning recoupments, requires a health care professional or health care provider to be provided a remittance advice that includes an explanation of a recoupment or offset taken by a managed care organization. Removes provisions permitting insurers contracted with the Department of Healthcare and Family Services to recoup or offset payments due to a federal Medicaid requirement. Provides that no contract between an MCO and health care professional or provider may provide for recoupments in violation of the Code. Effective January 1, 2027.
AI Summary
This bill, effective January 1, 2027, aims to improve the processes for healthcare providers working with managed care organizations (MCOs), which are private companies contracted by the government to manage healthcare services for Medicaid recipients. It mandates that MCOs must use a standardized universal provider application developed by the Council for Affordable Quality Healthcare (CAQH), a non-profit organization, for credentialing healthcare professionals and providers, and also for renewing those credentials. Within 180 days of new rules being adopted, all health and dental plan carriers must accept these CAQH applications. Furthermore, MCOs will be required to assign a provider network consultant to act as a liaison for healthcare providers, and the Department of Healthcare and Family Services will employ provider enrollment consultants to help providers navigate the Illinois Medicaid enrollment system and the credentialing process with MCOs. The bill also strengthens protections against recoupments, which are instances where an MCO takes back previously paid money from a provider; it requires MCOs to provide a clear explanation of any recoupment or offset on a remittance advice, and prohibits contracts that allow recoupments in violation of the law, removing an exception that previously allowed insurers contracted with the Department to recoup payments due to federal Medicaid requirements.
Committee Categories
Budget and Finance
Sponsors (1)
Last Action
Assigned to Appropriations- Health and Human Services (on 02/10/2026)
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