Agencies
Services
Managed Care Program Policies
- MCO-001 HFS Managed Care Provider Resolution Portal - February 2023 (pdf)
- MCO-003-Payment of Bad Debt (pdf)
- MCO-004-Children's Dental Network Upload Rqmts (pdf)
- MCO-005 - Reporting Death of a Member (pdf)
- MCO-006-Dispute Process-Claims (pdf)
- MCO-007-Dispute Process-Prior Auth (pdf)
- MCO-008-Electronic Visit Verification (pdf)
- MCO-009-Enrollee Materials Review Process (pdf)
- MCO-010-HRA-HRS Completion-Returning Enrollees (pdf)
- MCO-011 HEDIS-CAHPS Questions 07062020 (pdf)
- MCO-012 Home Delivered Meals Updated 12/02/2021 (pdf)
- MCO-013-Home Modification-DRS HSP (pdf)
- MCO-014-HSP Individual Provider Overtime (pdf)
- MCO-015-HSP PA Services Outside the Home (pdf)
- MCO-016-Move from Indiv Provider to Homemaker (pdf)
- MCO-017 - LTSS Hard to Reach Members (pdf)
- MCO-020 - Newborn Claims Processing (pdf)
- MCO-021 - Participant Transfer-Aging Clients to FFS (pdf)
- MCO-022 - Participant Transfer-Waiver Eligible (pdf)
- MCO-023 - Patient Credit File January 2024 (pdf)
- MCO-025 - Pharmacy Rebates (pdf)
- MCO-026 - Provider Directory Rqmts February 2023 (pdf)
- MCO-027 - Physician Termination from MCO February 2023 (pdf)
- MCO-028 - MCO Rate Questions (pdf)
- MCO-029 - Service Cost Maximum Letter October 2023 (pdf)
- MCO-030 - Specialized Family Support Program (pdf)
- MCO-031 - TPL for LTC and SLP Residents 06252020 (pdf)
- MCO-033 - Waiver Services Closeout MCO Responsibilities 09032020 (pdf)
- MCO-035 - Critical Incident Reporting (pdf)
- MCO-036 - Definitions-Enrollee Materials 07212020 (pdf)
- MCO-037 - PCS (HFS 2270) Form and Reporting 12192022 (pdf)
- MCO-041 - Reporting Key Position Changes February 2023 (pdf)
- MCO-043 - MCO Quarterly Attestation of Adherence to the Department's PDL February 2023 (pdf)
- MCO-044 - Aging and DRS DONs and SCMs (pdf)
- MCO-045 - Care Plan Deviations Policy (pdf)
- MCO-046 - Home Modifications Policy March 2024 (pdf)
- MCO-047 - MCO Enrollees in Neurorestorative (pdf)
- MCO-048 - Ride Share Waiver Utilization (pdf)
- MCO-049 - SharePoint Tracking and Monitoring February 2023 (pdf)
- MCO-052 - Annual Attestation of Adherence - Drug Utilization Review (pdf)
- MCO-055 - Community Transitions Initiative (pdf)
- MCO-057 - MCO MPR Reporting Policy February 2023 (pdf)
- MCO-058 - DRS HSP Training Policy (pdf)
- MCO-062 - DRS HSP Managed Care Case Manager Contact (pdf)
- MCO-064 – Provider Preventable Conditions Reporting January 2024 (pdf)
- MCO-065 – DRS Waivers – Legally Responsible Individuals March 2024 (pdf)
- MCO-066 – Elderly Waiver – Legally Responsible Individuals March 2024 (pdf)
- MCO-067 - HSW Reporting Process Policy January 2024 (pdf)
Sister Agency Policies
- IDoA - ADS (a) Adult Day Services Integrated Plan of Care 11.22.19 (pdf)
- IDoA - ADS (b) Health and Safety policy-POC 11.22.19 (pdf)
- IDoA - ADS (c) FAQs from Health and Safety-POC webinar 11.22.19 (pdf)
- IDoA - ADS (d) Fillable form - 1197_Plan of Care 11.22.19 (pdf)
- IDoA - ADS (e) Sample - 1197_Plan of Care 11.22.19 (pdf)
- IDoA - APS Report of Substantiation Process Policy 6.1.20 (pdf)
- IDoA - APS Reports of Self-Neglect Policy 6.1.20 (pdf)
- IDoA - CCP to MCO transitions 01.01.18 (pdf)
- IDoA - CCUs contracting with MCOs 08.01.15 (pdf)
- IDoA - Electronic data verification 01.01.18 (pdf)
- IDoA - IVMMP.MCO policy 01.01.18 (pdf)
- IDoA - MCO enrollee requiring services 01.01.18 (pdf)
- IDoA - MCO to CCU transitions 01.01.18 (pdf)
- IDoA - New referrals for services 01.01.18 (pdf)
- IDoA - Non-waiver services 01.01.18 (pdf)
- IDoA - SCP.MCO policy 01.01.18 (pdf)
- IDoA - Terming CCP for MCO prt 01.01.18 (pdf)