Provider Notice issued 05/19/11

Integrated Care Program

Beginning May 1, 2011, the Department of Healthcare and Family Services transitioned medical coverage for approximately 40,000 seniors and persons 19 years of age and older with disabilities from the existing fee-for-service system to a managed care service model. This new managed care initiative is called the Integrated Care Program (ICP). ICP enrollee health benefits, including pharmacy services, will be administered by Aetna Better Health and IlliniCare Health Plan. This transition will occur over the next few months with an expected completion by October 2011. Enrollment will be limited geographically to eligible Medicaid clients, not enrolled in Medicare, residing in DuPage, Kane, Kankakee, Lake, Will counties and suburban Cook county (excluding 606 ZIP Codes).

Because Medicaid pharmacy services for ICP enrollees will now be a covered benefit under the Aetna Better Health and IlliniCare Health Plan service plans, participating pharmacies will need to submit all billing transactions to the appropriate managed care organization coverage plan. All ICP enrollees will be required to present their plan issued health benefits card to the pharmacy at the point of sale. For claim transactions submitted directly to HFS, the department will return an error code and rejection message that reads as follows:

G39 RECIP IN MCO – INTEGRATED CARE

Again, ICP is administered through two managed care organizations, Aetna Better Health and IlliniCare Health Plan, and therefore provider participation is defined by each plan's respective service network. To get more information about ICP contact:

Aetna Better Health IlliniCare Health Plan

1-866-212-2851 (pharmacy option) 1-800-460-8988

Any additional questions regarding this notice may be directed to the Bureau of Managed Care at 217-524-7478 or to the Bureau of Pharmacy Services at 217-524-7112.

Theresa A. Eagleson, Administrator

Division of Medical Programs