Illinois Preferred Provider Programs: PPAs & PPPs

As a follow-up to our earlier post regarding approved preferred provider program administrators, there is some uncertainty and confusion over the terminology involved with preferred provider programs & HB 1698.

Currently, if you are a PPO operating in the state of Illinois, you need to be registered by the Illinois Department of Insurance as a preferred provider program administrator, also known as a preferred provider administrator or PPA.  There is an annual renewal process with the Department for every PPA in Illinois. 

The Department of Insurance keeps two lists of approved PPAs on their website: here & here.  The Provisionally Approved Companies list consists of previously approved companies with renewal applications in house at the Department. As the Department reviews and approves the renewal applications, those companies move to the Approved Companies list.

HB 1698 now allows an employer to utilize a “preferred provider program” (PPP) approved by the Department of Insurance for the direction of medical treatment of injured employees.  These new workers’ comp PPPs must comply with all of the existing PPA requirements, but the law also lays out additional requirements as well.

In addition to the specific PPP requirements described in Section 8.1a of HB 1698, the final portion of 8.1a states,

The Director of the Department of Insurance may promulgate such rules as are necessary to carry out the provisions of this Section relating to approval & regulation of preferred provider programs.

Until the Department releases its additional requirements, and begins the new PPP approval process, none of the currently approved PPAs are Department of Insurance–­approved workers’ comp preferred provider programs.

As a PPA with a successful workers’ comp network, HFN is prepared to meet all of the specific PPP requirements included in HB 1698.  HFN will immediately take the additional steps to become a Department of Insurance–approved WC preferred provider program once the Department establishes those new approval requirements. 

For more detailed information about these changes, or any WC reform issue, you can always use the comments section on the blog or email us directly.

For more information on HFN’s workers’ compensation products and solutions, contact Guy Swanson, HFN’s Director of Workers’ Comp, by email or at (630) 990-8609.