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  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 08/03/09

Illinois Health Connect Referral System Implementation – Phase I

To:​ All Enrolled Providers​
Date:​ August 3, 2009​
Re:​ Illinois Health Connect Referral System Implementation – Phase I​

In follow-up to previous provider notices, the Department of Healthcare and Family Services (HFS) and Illinois Health Connect are announcing the implementation of  The Illinois Health Connect Referral System will be implemented by Region, on the dates provided below:

 

  • Northwest Counties  - October 1, 2009

  • Collar Counties – December 1, 2009

  • Cook County – February 1, 2010

  • Central Counties – April 1, 2010

  • Southern Counties – April 1, 2010

The counties included in each Region is provided in Attachment A to this notice.

Phase I of the Illinois Health Connect Referral System is being implemented to continue the ongoing efforts to connect Illinois Health Connect patients with their medical homes.  By doing so, the patient’s Primary Care Provider (PCP) becomes familiar with their medical needs and ensures they receive the necessary preventive and primary care, including immunizations and screening, thus improving the quality of care for the patient through better coordination and management of services by the PCP.

 

Phase I requires patients to be seen by their own PCP or a physician or clinic affiliated with their PCP.  PCPs seeing patients enrolled in Illinois Health Connect but not enrolled on their panel, or on an affiliated PCP’s panel on the date of service, must obtain a referral from the patient’s PCP in order to be reimbursed by HFS for services provided.  PCPs will be able to submit referrals for their Illinois Health Connect patients to see other PCPs through the Illinois Health Connect Provider Portal via the secure MEDI system and directly with Illinois Health Connect via fax and phone.  Specialists will not require a referral in Phase I.

 

Once the implementation period has begun in a specific Region, all services by PCPs for Illinois Health Connect patients not enrolled on their panel, or on an affiliated PCP’s panel, in that Region on the date of service, will require a referral be registered in the Illinois Health Connect Referral System by the patient’s PCP in order to be reimbursed for services provided.  If no referral is registered by the patient’s PCP, the claim for the billing PCP will be processed but not reimbursed by HFS.  The billing PCP’s remittance advice will have a message that identifies the services that required a referral.  Payment for the services will not be made by HFS due to a lack of a referral from the patient’s PCP in the Illinois Health Connect Referral System. 

 

As the implementation of the referral system proceeds, PCPs should continue to encourage patients seeking services in their office, but not enrolled on their panel or on an affiliated PCP’s panel on the date of service, to see their PCP first.  Reinforcement by PCPs of the medical home concept will encourage Illinois Health Connect enrollees to access services available with their PCP and build upon the foundation of the medical home, resulting in better coordination and continuity of care for these patients.

 

More information about the implementation of the Illinois Health Connect Referral System, including training opportunities, outreach efforts, policies for use of the Referral System and clarification of the services that require or do not require a referral, will be distributed to all PCPs by Illinois Health Connect Provider Services within the next few weeks. 

 

Questions about this notice should be directed to the Illinois Health Connect Provider Help Desk at 1-877-912-1999.

 

Theresa A. Eagleson, Administrator

Division of Medical Program

 

Attachment A – Counties by Region (pdf)