HB2117 Summary

• MCOs must publish quarterly reports on their websites showing total claims received, number and monetary amount of claim payments to service providers, dates of service rendered, dates claims were received, and dates payments were released.

• MCOs must pay emergency services claims within 30 days of receiving complete information and notify billing parties within 30 days if unable to adjudicate a claim.

• MCOs must pay emergency service providers at the Illinois Medicaid fee-for-service rate including all applicable adjustments, even for non-contracted providers.

• Department shall publish quarterly MCO performance metrics including claims payment timeliness and accuracy, prior authorizations, grievances and appeals, utilization statistics, and provider credentialing.

• Department shall post analysis of MCO claims processing and payment performance every 6 months, including rejection and denial reasons and claims adjudication timeliness data.