HB2715 Summary

• Requires MCOs to pay any contracted provider for medically necessary services rendered to enrollees regardless of whether the provider appears on the MCO's published roster.

• Mandates MCOs update provider rosters within 7 days of entering into contracts and ensure rosters are readily accessible to enrollees for provider selection.

• Requires the Department to develop a single standard list of essential clinical information MCOs may request from hospitals to adjudicate claims, limiting information requests beyond this list.

• Establishes 30-day timely payment requirement for claims and mandates MCOs pay at least equal to Illinois Insurance Code penalty rates for late payments; MCOs must automatically calculate and pay timely payment interest penalties within 30 days.

• Requires MCOs to establish expedited payment schedules for providers on the Department's expedited provider list, potentially using Periodic Interim Payment programs mutually agreed to between MCO and provider.

• Requires MCOs to authorize or reject pre-service authorization requests within 4 calendar days (48 hours for urgent cases); failure to respond results in automatic approval and payment obligation.

• Prohibits MCOs from requiring additional medical necessity justification for previously authorized services and imposes double-payment penalties if MCOs deny authorized services or deny claims with sufficient documentation.