IL SB3163

Requires managed care organizations (MCOs) in Illinois Medicaid to use a universal CAQH credentialing application for provider enrollment and credential renewals, with health and dental plan carriers required to accept this application within 180 days of rule adoption.

Mandates all MCOs provide a dedicated provider network consultant to serve as liaison with healthcare 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 MCO credentialing processes.

Strengthens recoupment protections by requiring MCOs to provide detailed remittance advice explaining any payment recoupments or offsets, including patient name, service date, amount, and reason, along with appeal information.

Removes the exception allowing insurers contracted with the Department to recoup payments beyond 12 months based on federal Medicaid requirements, effective January 1, 2027.