SB1238 Summary

• Requires managed care organizations (MCOs) to publish quarterly reports on their websites showing total claims received, number and monetary amount of claims payments made to service providers, dates services were rendered, dates claims were received, and dates payments were released.

• Mandates MCOs pay emergency service providers at the Illinois Medicaid fee-for-service rate including all applicable adjustments, even without a contract with the MCO.

• Requires MCOs to pay claims within 30 days of receipt of complete information and impose penalties equal to those under the Illinois Insurance Code for late payments.

• Directs the Department to publish quarterly MCO performance metrics including claims payment timeliness, prior authorizations, grievances, appeals, and customer service, accessible to providers online by January 1, 2017.

• Takes effect July 1, 2019.