Harmony Health Plan is becoming part of Meridian Health Plan, in significant move for Illinois healthcare news. WellCare, the company that owns Harmony, recently bought Meridian for $2.5 billion. As a result, Harmony members will automatically be enrolled with Meridian on Jan. 1. “Nothing changes,” WellCare assured them, noting that “Meridian’s list of doctors is large, just like Harmony’s.” The move brings big changes to Illinois medicaid managed care insurers.
The move is extremely beneficial for Harmony, which was previously losing enrollees after the state suspended its automatic Medicaid enrollments, in June, The Illinois Department of Healthcare and Family Services (HFS) said the insurer didn’t have a large enough statewide provider network.
The consolidation brings the state’s overhauled Medicaid managed care program back to six insurers. Launched a little under a year ago, the state’s revamped Medicaid managed care program called HealthChoice Illinois reduced the number of insurers from 12 to seven.
One of them is Blue Cross and Blue Shield of Illinois (BCBSIL). The insurer was also penalized $150,000 and placed on an enrollment hold in April for not having enough doctors and hospitals in its network to ensure adequate access for members in certain areas. It also failed to address a backlog of grievances and appeals from members.
Now, BCBSIL is almost in the clear. As of last month, Medicaid enrollees can once again select plans from the largest insurer in the state.
Teresa Hursey, HFS’ interim director, said Blue Cross “was able to point to changes the health plan has made to come into compliance.” Even so, automatic enrollments, remain on hold until December, when the HFS scheduled a follow-up.
Blue Cross spokeswoman Colleen Miller said his company is committed to making things right for its members and will continue to make improvements in their technology.
Most insurers participating in HealthChoice Illinois were fined at one point, including Molina Healthcare of Illinois and NextLevel Health.
This article comes from JGBilling