IL HB4378

Requires managed care organizations (MCOs) to use a universal CAQH credentialing application for providers seeking to join their networks, with health and dental plan carriers required to accept the application within 180 days of rule adoption

Mandates all MCOs provide a provider network consultant as a liaison for health care providers, with contact information provided upon enrollment and annually thereafter

Directs the Department of Healthcare and Family Services to employ provider enrollment consultants to help providers enroll in the Illinois Medicaid Program Advanced Cloud Technology system and navigate credentialing processes

Requires remittance advice to include detailed explanations of any recoupments or offsets taken by MCOs, including patient name, service date, service code, amount, and reason

Removes the exception allowing insurers contracted with the Department of Healthcare and Family Services to recoup payments based on federal Medicaid requirements, effective January 1, 2027