Comptroller's proposed measure targets Medicaid claim reporting

Comptroller's proposed measure targets Medicaid claim reporting

SPRINGFIELD — Illinois Comptroller Susana Mendoza wants more transparency from the managed-care organizations administering billions of dollars in state Medicaid payments.

Her bipartisan initiative introduced Wednesday by state Rep. David McSweeney, R-Barrington Hills, and state Sen. Laura Fine, D-Glenview, would compel the managed-care organizations administering the bulk of the state's Medicaid program to post quarterly reports on their websites about their Medicaid claims with details about the claims' payment history.

Specifically, managed-care organizations have to report the number of Medicaid claims they received for the quarter, the number and amounts paid to medical providers and dates for when the medical services that generated the claims were provided, when the claims for the payments were received and when the payments were made.

The so-called Managed Care Organization Transparency Act was introduced following Illinois' massive expansion of Medicaid Managed Care in 2018.

The state relies on managed-care organizations to administer most of the Medicaid program, but there's little information available about when doctors, hospitals and other providers can expect the payments they're owed from the organizations, according to Mendoza.

"As the state's chief fiscal officer, I cannot see what happens to billions of taxpayer dollars after my office releases them to the MCOs," she said. "I frequently hear from providers whose Medicaid payments have been delayed. They often have no idea when their payments might come."

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