MedicaidAdministrativeMedium impact
Continuity of Care Requirements for HealthChoice Illinois Managed Care Health Plans
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Apr 13, 2018
We identified it
Jun 20, 2026
Summary
HealthChoice Illinois Managed Care Organizations (MCOs) must provide a 90-day continuity of care transition period for new enrollees to continue treatment with out-of-network providers. Out-of-network providers will be paid at current fee-for-service rates during this period but must follow the MCO's referral and preauthorization policies.
Action Required
Immediately: Billing team should verify HealthChoice Illinois MCO contracts include 90-day continuity of care provisions. When treating new MCO enrollees who were previously established patients, confirm eligibility for continuity of care benefits and obtain required preauthorizations per each MCO's policies. Ensure billing system can process out-of-network claims at fee-for-service rates during the 90-day transition period.