The State of Illinois continues to have a significant delay in paying or reimbursing claims for some insurance plans. If you participate in the MCAP, find help below to submit your claims during this delay.
Which insurance plans have a payment delay?
The Quality Care Dental Plan (Delta Dental), the Quality Care Health Plan (Cigna ending June 2017, Aetna beginning July 2017), HealthLink OAP, and Aetna OAP (formerly Coventry) continue to experience delays. See the CMS Claim Payment Delay page for current claim payment progress.
What amount will the MCAP reimburse?
In some cases, such as for out-of-network dental appointments, you may have paid the full amount of the charges upfront. However, you can only request MCAP reimbursement for the portion of the charges that insurance won’t cover. Your maximum MCAP reimbursement amount is the amount you will ultimately be responsible for after any insurance payments.
How do I submit MCAP claims during the state’s payment delay?
Continue to pay for MCAP-eligible expenses by using your ConnectYourCare (CYC) payment card, or by paying out-of-pocket and then requesting reimbursement via the CYC website, using the CYC mobile app, or by submitting a paper claim form via fax or mail.
When you are required to submit documentation to substantiate a claim, CYC will need the following from you:
- An itemized receipt for services that shows what charges will be covered by insurance, and/or
- An Explanation of Benefits (EOB), which shows what portion insurance will pay.
How do I find the Explanation of Benefits (EOB)?
Access your EOB online, which you can submit to CYC, even if your healthcare provider has not yet received payment from the state for your insurance claim.
If you do not have access to the Internet, then you can call your insurance company directly to request the EOB. The insurance company phone number will be on the insurance ID card they sent to you at the beginning of the plan year.
Important Timeframe Reminders
- Expenses for FY 2017 must have been incurred during the period July 1, 2016 through June 30, 2017, and must be submitted to CYC for reimbursement no later than September 30, 2017.
- Expenses for FY 2018 must be incurred during the period July 1, 2017 through June 30, 2018, and must be submitted to CYC for reimbursement no later than September 30, 2018.
For questions about submitting MCAP claims, contact ConnectYourCare at 888-469-3363.
For assistance with finding your Explanation of Benefits (EOB), contact your insurance company directly.
For all other MCAP questions, contact University Payroll and Benefits (UPB):