Learn more about CHC’s payor contracts – make it a habit to regularly check this page for updated information about each CHC payor contract, including important product/plan information, operational and administrative processes that are necessary to follow to ensure services you provide are covered and reimbursed, provider portal access links, sample member ID cards, and much more!
CHC Payor Contract Highlights and Resources
CAQH: Please update your provider CAQH profile. Insurers use CAQH to credential and re-credential doctors and other providers. Make sure the provider CAQH profile is set to allow access to all plans attempting to access the information.
Since January 1, 2017, CHC has partnered with Blue Cross and Blue Shield of Illinois in a shared savings, upside-only Commercial ACO agreement built on a value-based incentive model that rewards CHC for meeting quality, performance, and cost targets. The ACO agreement utilizes a provider’s or group’s existing Blue Cross and Blue Shield PPO agreement and is not a new plan or HMO.
Bright Health, a Medicare Advantage plan, is brand new and will launch in Illinois on 01/01/2020.
- Humana Coordinated Care Network (CCN) is a “narrow network”- based care delivery model, consisting of seven provider systems or “micro-networks”
- CHC is participating as part of the Loyola Physician Partners system
Comprehensive Provider Manual – See Provider manuals and related documents section
MeridianTotal (formerly known as IlliniCare Health Medicare-Medicaid Plan ((IHMMP)) (effective 06/26/2020)
Since 2017, CHC has participated with the IlliniCare Health Medicare-Medicaid Plan (“IHMMP”), a plan that covers individuals who have dual eligibility for both Medicare and Medicaid.
The parent company of IHMMP—Centene Corporation—recently sent notice that effective June 26,2020 the IHMMP name was being discontinued and the new, rebranded name of this plan would now be MeridianTotal.
The terms of CHC’s participation with IHMMP extend and carry over to MeridianTotal; as such, CHC providers are therefore considered in-network and participating with MeridianTotal, as of June 26. New ID cards bearing the MeridianTotal name and logo have been issued (a sample card, front and back, is available below), and members have been instructed by Centene to discard and no longer use the former IHMMP ID cards. Please advise any impacted staff that patients who present with an active MeridianTotal ID card should be accepted.
- MeridianTotal is a Medicare Advantage D-SNP plan, or Dual Eligible Special Needs Plan
- Individuals enrolled in D-SNP plans are eligible for coverage under Medicare (as primary) and Medicaid (as secondary)
- Please note: CHC does not participate in Meridian’s Medicaid plan, Meridian Health, HealthChoice Illinois Mediciad program.
- Like the Sunrise Advantage I-SNP plan, Longevity is an Institutional Special Needs Plan, or I-SNP
- I-SNP plans are a specialized type of Medicare Advantage plan for residents of skilled nursing facilities and other long-term care facilities , such as senior living or assisted living communities
Sunrise Advantage Plan is a Medicare Advantage payor that offers three plans in the Illinois market:
- Sunrise Advantage I-SNP Plan, or Institutional Special Needs Plan
- For residents of skilled nursing facilities and other long-term care facilities, such as senior living or assisted living communities
- Sunrise Advantage C-SNP Plan, or Chronic Condition Special Needs Plan
- For individuals with a diagnosis of dementia
- Sunrise Advantage Plan MAPD, or Medicare Advantage Prescription Drug Plan
- A more “traditional” Medicare Advantage plan that does not have the I-SNP skilled nursing facility/long-term care facility residency requirement or the C-SNP dementia diagnosis requirement
The Council on Affordable Quality Healthcare (CAQH) is utilized across the healthcare and insurance industry as a centralized repository of provider information for credentialing and contracting purposes.
The health insurance credentialing and contracting process can be delayed and even abandoned by the insurer if information such a professional liability and licensure dates are not updated with CAQH.
Visit: https://proview.caqh.org/ to learn more and access or create a provider account.
When updating or creating a CAQH provider profile, one important aspect is allowing health plans permission to access the provider profile for credentialing and contracting purposes.