Health Maintenance Organizations (HMOs)
Health Maintenance Organizations are corporations that are financed by insurance premiums and have member physicians and professional staff who provide curative and preventive medicine within certain financial, geographic, and professional limits to enrolled volunteer members and their families.
For information on filing a complaint or checking the status of a current complaint, please visit our complaint section.
Health Care Professional Credentialing
The Health Care Credentials and Data Collection Act requires uniform forms to be utilized in order to collect the credentials data commonly requested by health care entities and health care plans for purposes of credentialing and recredentialing. The forms required for use by the Health Care Professional Credentialing and Data Collection Act (410 ILCS 517) are located under the Forms section on the right-hand side of this page.
"These forms are for use with the entity or entities that are conducting the credentialing. DO NOT SEND COMPLETED FORMS TO THE STATE. Please contact the health care plan, health care entity or hospital that is reviewing your credentials for instructions on where to send this form and any other information it may require in order to complete the credentialing process."
Frequently Asked Questions
What is the process to add counties to the HMO service plan?
The HMO shall send the Department a letter listing the counties the HMO currently is providing enrollment and the new additional counties that the HMO request to serve. In addition, include documents listing the physicians and their specialty; office address and Illinois license # that the HMO has contracted with to service the enrollees in the new counties. And include the health care providers that the HMO has contracted with for the new counties (hospitals, Home health etc).