IL SB2949

Requires Managed Care Organizations (MCOs) to accept prior approval requests 24/7/365 from nursing home residents, physicians, and providers (changed from "for" to "from" to include all three groups).

Allows enrollees, physicians, or providers to file expedited appeals when a resident's physician orders a non-emergency service that the MCO denies, with MCO notification of decision required within 24 hours of receiving all required information.

Mandates MCOs review and pay claims submitted in proper form within 30 days of receipt, with rejected or denied claims accompanied by detailed corrective action descriptions.

Requires MCOs to notify providers by phone and provide assistance when claims are rejected or denied a second time to help correct deficiencies.

Establishes a claims mediation process to be contracted by the Department within 90 days, funded by annual fees from MCOs, with guidelines and application forms published on the Department's website.