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Managed Care License / Registration Information

Utilization Review Organization: Application for Registration (Health Care & Worker’s Comp.)
Independent Review Organization: Application for Registration
Independent Review Organization: Application for Renewal
Article XX-1/2 Health Care Reimbursement from 215 ILCS 5/370 f. through r.
Part 2051, Preferred Provider Program Administrator from Illinois Administrative Code, Title 50
HMO or LHSO Certificate of Authority Application Information can be obtained from Amy Stuart, Supervisor LAH Corporate Unit

Preferred Provider Program Administrator Registration and Checklist Forms:

Health Care Preferred Provider Program Administrator Registration Form Updated: 01-07-2020 PDF
Discounted Health Care Services Plan Only Registration - Updated: 01-07-2020 PDF
Insurer Filing Requirements Updated: 01-08-2020 PDF
Workers’ Compensation Preferred Provider Program Administrator Registration Form Updated: 01-08-2020 PDF
NAIC Biographical Affidavit Form PDF
Preferred Provider Program Administrator Bond/Fiduciary PDF

Offices

Illinois Department of Insurance
122 S. Michigan Ave, 19th Floor
Chicago, IL 60603
(312) 814-2420

Illinois Department of Insurance
320 W. Washington St.
Springfield, IL 62767
(217) 782-4515

Managed Care License / Registration Information

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