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Medicaid Claims Database and the Primary Care Case Management Program

    • In April 2010 the ISMS House of Delegates adopted Substitute Resolution 32 (A-10), directing ISMS to educate members about the availability of the Medicaid Claims History Database, how it can be accessed and how it may be of help to physicians treating Medicaid patients. The following information provides:

      • The history of the Primary Care Case Management Program (PCCM).
      • Referral requirements.
      • The purpose and use of the Medicaid Claims History Database and summary of the data available.
      • How to access the data.
      • Resources for additional information or assistance.


      The Illinois Department of Health Care and Family Services (HFS) implemented its PCCM program in July 2006. This program is called Illinois Health Connect (IHC) and is administered by Automated Health Services.

      Under this program, eligible recipients are required to select a primary care provider (PCP) to serve as their medical home. Recipients are given 60 days to select a PCP. If they do not choose a particular PCP, one will be assigned. A PCP enrolled with Illinois Health Connect serves as a patient's primary and preventive care needs. In some areas, patients may opt out of the IHC program and select a PCP in a managed care organization. Patients also can choose their current physician or clinic to serve as their PCP if that physician or clinic is enrolled as a provider with DHFS and also enrolls as a PCP with IHC.

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