Jan. 13, 2025
Illinois House Bill 5395 (Public Act 103-0650), also known as the Healthcare Protection Act or HCAPA, requires auditing of all Commercial and Qualified Health Plan network directories every 90 days.
What does this mean for you? For compliance with increased auditing requirements, we’ll reach out to your offices to verify all elements listed within our provider directories:
- You’ll get a phone call on behalf of Blue Cross and Blue Shield of Illinois once every 90 days to verify your provider information is accurate.
- Additionally, as required, we’ll contact you if you haven’t submitted a claim to BCBSIL within the last 12 months or otherwise communicated your intent to continue participation in our network.
How can you prepare? Here are some important provider demographic components to routinely review for each provider in your practice:
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Background on the bill: HCAPA sets requirements on insurance companies related to member costs and health care coverage. HB 5395 includes amendments to the Illinois Network Adequacy and Transparency Act for plans issued or renewed on or after Jan. 1, 2025. There are other statutory provisions amended by HB 5395 that will go into effect on or after Jan. 1, 2026.
The details: Among other changes, HB 5395 requires compliance with appointment wait time standards established under NATA or federal law. It also adds new mandatory fields to be included in provider directories and requires auditing of all Commercial and Qualified Health Plan network directories every 90 days rather than auditing a portion of provider directories on a periodic basis.
Keep your information up to date: Don’t wait for us to call. Update your demographic information as soon as you have a change by using the Provider Data Management feature in Availity® Essentials. If you’re unable to use Availity, use our Demographic Change Form. If you’re a group (Billing NPI Type 2) and have more than five changes, email our Provider Roster Requests team to get a current copy of your roster for your multiple-change request. Related to HB 5395, the roster includes a new field for appointment availability. Learn more about how to verify and update your information with BCBSIL.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.