Specialist Information

The Illinois Department of Healthcare and Family Services (HFS, formerly the Illinois Department of Public Aid) has moved to a Primary Care Case Management (PCCM) model for most medical program (Medicaid and All Kids) participants. This program is called Illinois Health Connect.
Illinois Health Connect is administered by Automated Health Systems.
The goal of Illinois Health Connect is to enhance primary and preventive care services for approximately 1.6 million participants through the concept of a "medical home". Twenty-nine other states have adopted similar models for their Medicaid participants and have shown a gradual decrease in ED usage, an increase in primary care and preventive services (such as immunizations) for patients, and decreased costs.
In Illinois Health Connect, eligible participants will choose one Primary Care Provider (PCP) to act as their "medical home".
Physicians willing to provide a medical home for patients must enroll as an Illinois Health Connect PCP. Physicians can specify how many patients they want in their panel from 1 to 1,800 and limit the panel based on existing patients, age limits or gender.
PCPs will receive a monthly care management fee in addition to the regular fee-for-service reimbursement from HFS.
PCPs enrolled in Illinois Health Connect will provide referrals for patients to see other HFS enrolled providers or specialists.
Referrals are registered with AHS via an internet based system, phone, or fax. Referrals are NOT reviewed for medical necessity or “pre-authorized”.
Patients will NOT require a referral to receive care in the Hospital or ED.
Labs, diagnostic studies, PT/OT/ST will NOT require referrals.
Specialists who provide global primary care for certain groups of patients should register as a PCP in order to continue to provide primary care services without a referral for those patients.
AHS is developing a Specialty Resource Database that will assist PCPs in identifying specialists who are available to care for HFS clients.
Registration in the Specialty Resource Database will also facilitate the administration of the referrals. If a specialist registers and indicates his/her partners, then one referral registered by a PCP will "cover" any member of the specialty group who provides care to the patient.
Specialists who wish to be included in this Database should contact the Provider Helpdesk at 1-877-912-1999 or register online (see below)
HFS has also implemented a parallel program for Disease Management called Your Healthcare Plus. This program is administered by McKesson Health Solutions and will target 235,000 Medicaid participants who have chronic illnesses, including asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and heart failure.

Specialist Registration

There are two ways that specialists can register with Illinois Health Connect:

Print, fill out, and send in the Specialist Registration form by mail to Automated Health Systems, 1375 East Woodfield Road, Suite 600, Schaumburg, IL 60173 or fax to 847-995-0827.
If you have an HFS provider ID number, you may submit your Specialist Registration online.
To apply online, you will need your HFS provider number and your provider type. For most physicians not affiliated with a Federally Qualified Health Center (FQHC) or Rural Health Center, the HFS number is the same as your IL license number. If you are affiliated with an FQHC or RHC, please check with your clinic administrator to determine your HFS number.

Once you have completed the Specialist Registration process, all Providers will need to register with the Illinois Department of Healthcare and Family Services' Medical Electronic Data Interchange System or "MEDI" in order to:

Access client claims history.
View a "panel roster" or list of patients assigned to each clinic or physician.
View location of service information.
Check the status of a referral.

If you want to access or enroll with MEDI, proceed to the MEDI System.

If you require assistance, please contact our Illinois Health Connect Provider Services Helpdesk at 1-877-912-1999 (TTY: 1-866-565-8577), Hours: Monday - Friday 7 a.m. to 6 p.m. The call is free.