Illinois Medicaid — HealthChoice Illinois
| Program name | HealthChoice Illinois |
|---|---|
| Provider portal | https://hfs.illinois.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 180 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Illinois Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Illinois
The Blue Cross Blue Shield Association licensee in Illinois is Blue Cross and Blue Shield of Illinois (HCSC). This licensee is not yet in the QuickIntell payer registry. See the full payer directory or the BCBSA national site for a provider-portal link.
Top commercial payers in Illinois
The dominant commercial insurers operating in Illinois, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Illinois
HealthChoice Illinois contracts with the following managed-care organizations to administer Medicaid benefits in Illinois. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Illinois
Wellpoint Federal is the Medicare A/B MAC for Illinois: Part A and Part B fee-for-service claims from Illinois go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by Palmetto GBA. In the current Medicare Coverage Database export, 159 active LCDs from these contractors apply to Illinois claims.
- Wellpoint Federal
A/B MAC (Part A and Part B claims)
- CGS Administrators, LLC
DME MAC (durable medical equipment and supplies)
- Palmetto GBA
Home health and hospice MAC
Selected active Wellpoint Federal policies for Illinois
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L33627 Non-Invasive Vascular Studies
- L33394 Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
- L35936 Facet Joint Interventions for Pain Management
- L39036 Epidural Steroid Injections for Pain Management
- L35000 Molecular Pathology Procedures
- L33577 Transthoracic Echocardiography (TTE)
- L33631 Outpatient Physical and Occupational Therapy Services
- L33632 Psychiatry and Psychology Services
- L33557 Cardiac Catheterization and Coronary Angiography
- L33569 Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)
- L33636 Routine Foot Care and Debridement of Nails
- L33622 Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts
Equipment, home health and hospice policies that apply in Illinois
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L34544 Hospice - Liver Disease
- L34547 Hospice - Neurological Conditions
- L34548 Hospice Cardiopulmonary Conditions
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Illinois billing
- IL Network Adequacy and Transparency Act (215 ILCS 124)
- 215 ILCS 5/368a (IL prompt pay — 30 days electronic clean claim)
- Hospital Uninsured Patient Discount Act (210 ILCS 89)
Provider licensing & enrollment in Illinois
Providers enroll with IL Medicaid via IMPACT (Illinois Medicaid Program Advanced Cloud Technology). All HealthChoice Illinois MCOs require IMPACT enrollment first.
Major health systems headquartered in Illinois
| Health system | Headquarters |
|---|---|
| Advocate Health Care (part of Advocate Health) | Downers Grove, IL |
| Northwestern Memorial HealthCare | Chicago, IL |
| Rush University System for Health | Chicago, IL |
| University of Chicago Medicine | Chicago, IL |
| Endeavor Health (Edward-Elmhurst + NorthShore) | Evanston, IL |
Frequently asked questions — Illinois billing
What is the Illinois Medicaid program called?
Illinois's Medicaid program is known as HealthChoice Illinois. Providers enroll and manage claims through the provider portal at https://hfs.illinois.gov.
What is the Illinois Medicaid timely filing limit?
HealthChoice Illinois requires initial claims to be filed within 180 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Illinois's 180-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Illinois Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for HealthChoice Illinois. Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Illinois?
The dominant commercial payers in Illinois include UnitedHealthcare, Aetna, Cigna, Humana, along with the BCBS licensee Blue Cross and Blue Shield of Illinois (HCSC). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Illinois?
HealthChoice Illinois contracts with 3 Medicaid MCOs tracked in the QuickIntell registry, including Centene, Aetna, Molina Healthcare. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Illinois?
Illinois has 3 tracked state-level statutes that affect medical billing and RCM: IL Network Adequacy and Transparency Act (215 ILCS 124); 215 ILCS 5/368a (IL prompt pay — 30 days electronic clean claim); Hospital Uninsured Patient Discount Act (210 ILCS 89). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Illinois with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to HealthChoice Illinois and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Illinois Medicaid and the member ID card before submission.