IL HB6123

Establish a web-based provider inquiry portal by January 1, 2018 for managed care organizations and providers to submit inquiries and requests for assistance.

Require managed care organizations to accept prior approval requests 24 hours a day, 7 days a week, 365 days a year from nursing home residents, physicians, or providers, with payment required if no response is provided within 24 hours for physician-ordered covered services.

Allow enrollees, physicians, or providers to request expedited appeals for non-emergency services denied by managed care organizations, with the MCO required to notify the appellant of its decision within 24 hours of receiving required information.

Require managed care organizations to review and pay clean claims within 30 days of receipt and provide claim status updates within 60 days, with rejected or denied claims clearly stating reasons in sufficient detail.

Mandate managed care organizations provide providers with a manual explaining billing and claims payment procedures within 15 days of contract execution, including all coding and documentation requirements, with 30-day notice required for any subsequent changes.