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Frequently Asked Questions
Is there a charge for a physician to join ELMCARE?
Yes, there is a membership fee of $1,000 for primary care physicians and $2,000 for specialists when joining ELMCARE. Physicians submit the fee along with the credentialing application when joining ELMCARE.
There is a $100 recredentialing charge. This fee is due when the physician is recredentialed according to the State of Illinois Recredentialing Cycle every 3 years.
ELMCARE is contracted with which health plans?
For the most current health plan list, click here.
If a physician wishes to join ELMCARE, must he/she participate in all ELMCARE contracted health plans?
ELMCARE provides physicians with choice to select the level of managed care involvement by participation in either or both risk HMO plans and non-risk PPO and POS plans. In addition, ELMCARE has right of first refusal allowing physicians to contract directly with any plans in which ELMCARE is not contracted.
Are there any requirements to join ELMCARE?
Yes, the three criteria are:
Yes, podiatrists and oral surgeons may apply to ELMCARE if they meet the 3 ELMCARE criteria for membership. In addition, certain other provider specialties are contracted with ELMCARE when specific services are needed. These specialists are not credentialed, and not considered ELMCARE owners.
What is the process to join ELMCARE?
Physicians wishing to join ELMCARE must complete a pre-application form so that it is confirmed that all membership criteria are met. Once this one- page application form is received and reviewed, ELMCARE Credentialing staff will forward a copy of the Illinois State Mandated Credentialing Application to the physicians for completion.
When the physician returns the application and membership fee, ELMCARE staff will begin the verification and credentialing process. The entire process usually takes 4 weeks to complete during which time, ELMCARE staff communicates with the physician regarding the application, documents and interview appointment. Every new physician is interviewed by the entire ELMCARE Credentialing Committee at the monthly meeting, and receives a site visit by the ELMCARE clinical staff.
Once the physician has been interviewed and the Credentialing Committee recommends membership, the physician needs to be approved by the ELMCARE Board of Managers and the Elmhurst Physician Association Board of Directors.
Once both Boards approve the physician, ELMCARE staff notifies the non-risk plans (PPO and POS plans) of the physician’s addition. ELMCARE staff notifies each physician in writing when they are effective with ELMCARE.
What if the physician wishes to join the risk plans through ELMCARE?
The physician is not automatically added to the ELMCARE risk plans. Physicians wishing to join the risk HMO plans, must apply in writing to the ELMCARE staff . (All physicians that are being added to existing risk HMO participating practices are automatically added to the HMO plans once they are credentialed and approved by the Boards). The physician’s application will be reviewed by the appropriate ELMCARE physician group participating in the Risk HMO plans.
How does the risk HMO contracts work at ELMCARE?
ELMCARE is contracted with North American Medical Management (NAMM) to manage the risk HMO lives and all health plan contracted requirements. These operations include referrals, pre-certification, utilization management, quality management, reimbursement to ELMCARE physicians, and claims payment.
NAMM manages the risk portion of the ELMCARE business through the maintenance of physician networks called Physician Organized Delivery Systems (PODS). These physician PODS are made up of both primary care and specialist physicians. The PODS physicians meet monthly to review utilization, financial, quality and membership data, and are responsible for the composition of the PODS panel and the overall success of their individual PODS.
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