April 28, 2025 [Updated May 1, 2025]
Among other changes, Illinois House Bill 5395 (Public Act 103-0650) requires auditing of all commercial and Qualified Health Plan network directories every 90 days. On Jan. 13, 2025, we alerted you we’d be calling your office once every 90 days to verify all elements listed within our provider directories.
Based on your feedback, we’ve made some changes to reduce the volume of calls to your office:
- Commercial provider groups: Effective immediately, we’re requiring that you submit a complete roster every 90 days (at least once every quarter). This means that by July 2025, you should have submitted an updated roster to us. If you’re currently submitting rosters regularly, please continue with your normal process once every quarter. This roster process allows us to audit provider data within our network directories. We’ll call you if we don’t receive a roster.
- Commercial solo professional providers: We encourage you to submit a roster to meet the 90-day verification requirement. It’s the most efficient way to verify all directory information and will help reduce calls to your office for verification purposes.
HMO Medical Groups or Independent Practice Associations: Continue with your normal process of submitting your complete, updated roster every month rather than every 90 days.
Why it matters: Updating and verifying your provider data is required to help ensure accuracy of your information in our network directories. It’s also required to help ensure your continued participation in our networks.
How does the roster process work? There are two roster options to fulfill the requirement:
- Email the Provider Roster Requests team every quarter to obtain the current roster for your group. Review your information for accuracy and make updates if needed. Submit your completed roster to the Provider Roster Requests team, or
- Submit a complete, updated version of the Universal Illinois Association of Medicaid Health Plans Roster at least once every quarter to our Provider Roster Requests team
If we haven’t received a roster within the last 90 days, we’ll call you to request your roster submission and to verify your information.
- If we don’t receive a roster within 10 business days of phone outreach, your provider information may be removed from our network directories for 60 days.
- If we receive a roster within 60 days of directory removal, we’ll review your submission to determine whether provider information will be restored in our network directories.
- If we don’t receive a roster within 60 days of directory removal, affected providers may be terminated from the applicable networks.
For more information: Refer to verify and update your information. If you have questions, contact your Provider Network Consultant.