CHC Payor Contract Highlights and Resources

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!

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.

Blue Cross and Blue Shield of Illinois Commercial ACO (BCBSIL ACO)

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.

Blue Cross and Blue Shield ACO Improvement Initiatives

Blue Cross and Blue Shield Commercial ACO Quality Measures

Ambetter

Ambetter – a Health Insurance Marketplace/Commercial Exchange plan offered through IlliniCare Health is effective with CHC as of March 1, 2017.

First Step – Create a Provider Portal Account

Provider Home Page

Important Phone Numbers

Sample ID Card – page 27

Comprehensive Provider Manual

Provider Resources

Humana Coordinated Care Network (Humana CCN)

Humana Coordinated Care Network (CCN) is an innovative, narrow-network based care delivery model that Humana launched on December 1, 2017. Humana CCN consists of seven provider systems or “micro-networks”; CHC is participating as part of the Loyola Physician Partners system.

First Step – Create a Provider Portal Account

Provider Home Page

Important Phone Numbers

Sample ID Card

Comprehensive Provider Manual – See Provider manuals and related documents section

Provider Resources

IlliniCare Health Medicare-Medicaid Plan (IlliniCare Health MMP)

On March 1, 2017, CHC entered into an agreement with IlliniCare Health to participate in the IlliniCare Health Medicare-Medicaid Plan (MMP) – A Medicare Advantage D-SNP plan (Dual Eligible Special Needs Plan).

Please note: CHC is neither participating nor in-network for IlliniCare Health HealthChoice Illinois (this is the Medicaid only product).

 

First Step – Create a Provider Portal Account

Provider Home Page

Important Phone Numbers – see page 4

Comprehensive Provider Manual

Provider Resources

Sample ID Card – see page 9

Sunrise Advantage Plan

Sunrise Advantage Plan is a Medicare Advantage payor that is new to the Illinois market for 2018. Sunrise Advantage Plan members are primarily residents of the Sunrise Senior Living communities. The effective date of the Sunrise Advantage Plan-CHC agreement is January 1, 2018.

Plan Resources:

First Step – Create a Provider Portal Account

Provider Home Page

Important Phone Numbers – see page 1

Sample ID Card – see page 2

Comprehensive Provider Manual

Provider Resources

Contact

For further information or questions about contracting or credentialing, please contact John Cepek, Director of Managed Care.

JCepek@PalosHealth.com

P: 708-923-5014

CAQH More Information

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.

Tip sheet: how to allow all plans access to your CAQH profile