About HealthSystems of Illinois
HealthSystems of Illinois (HSI), with its main
office in Lombard, is part of a multi-state health care
quality improvement company founded in 1986 as a nonprofit organization. Providing utilization review and quality improvement services under contracts with both Medicare and Medicaid, HSI is a certified
independent review organization and has worked in several federal programs, including CHAMPUS for the Department of Defense.
HSI works under contract with the Illinois
Department of Healthcare and Family Services (HFS) to provide Medicaid
certification for admissions, concurrent and continued stay, as
well as retrospective prepayment and postpayment review for inpatient care in a combination of medical/surgical and psychiatric facilities. HSI provides
quality of services review, including medical necessity and
reasonableness and appropriateness of care using telephonic, on-site and Web-based interactions. Dedicated to continuous quality improvement, HSI provides educational services for Medicaid
providers and participants to support these activities.
Three key words describe HSI's core beliefs:
dedication, improvement and quality. We also believe quality Health
care and review are inseparable from Systems.
The merger of those two beliefs – "real-time" health decisions supported by the latest data
systems – is our most distinguishing feature and gives us
a substantial advantage that is reflected in our history and our name, HealthSystems of Illinois.
It is our corporate goal, and our goal for each
employee, to deliver the most responsive and effective service possible to the Illinois Department
of Healthcare and Family Services, as well to Medicaid participants and
providers of Illinois.
Dedication, improvement and quality are our watchwords at HSI.
They are embodied in our pledge to our client and our employees:
Commitment First...a mindset to exceed goals - to build now for future challenges
Our Customer Commitment
HealthSystems of Illinois operates with a customer service frame of mind.
HSI management and staff are energetic professionals who continually seek opportunities for improvement to provide our customers - the health care providers of Illinois
- with superior service.
The HSI team
is comprised of leaders in innovative thinking and design meeting today's health care challenges. HSI has developed state-of-the-art data management systems and internal quality control practices for Medicaid utilization review services for Illinois. HSI employs highly creative, energetic, clinical professionals to work in a fast-paced, time-sensitive environment. Team members possess strong communication and organizational skills, as well as experience in highly successful utilization review, clinical
quality improvement, operations management, consulting and clinical education services.
The seasoned management and staff of HSI have more than
16 years Medicare and Medicaid experience, including the development of proprietary data management systems to support real-time decision making. HSI is committed to fostering excellent customer service to allow our clients - the health care providers of Illinois -
to make critical health care decisions by providing timely, professional and clinically sound
certification and review services. HSI has demonstrated leadership as experts in quality improvement and health care utilization review.
HSI staff understand the importance of accurate information, quick response, and real-time decision making and are dedicated to those goals.
What We Do - HealthSystems of Illinois...
Provides leadership in fostering cooperation and
building partnerships within the health care community to increase value and quality in the health care
Develops and implements cost-effective and
innovative utilization programs, health care quality
improvement projects and assessment technology.
Educates health care providers and consumers in
the purpose, structure and process of federal and
state health programs.
Medicaid review for:
Retrospective pre- and post- payment
Telephonic, on-site and Web-based interactions
Quality improvement program
Trending analysis - utilization, coding/DRG,
quality and billing practices
External quality review oversight for managed care
Provider education on HSI services and procedures
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Director and Associates
What is HealthSystems of Illinois?
HealthSystems of Illinois is a leader in the
pursuit of significant and continued improvement in health care
quality and effectiveness. HSI's systems approach is to engage
health care practitioners, managers, purchasers and consumers in collaborative efforts. We strive to address
quality and clinical issues to find pragmatic solutions to today's
health care delivery challenges. HSI is dedicated to excellent
working relationships with physicians, hospitals and clinics.
HSI is led by corporate
management with years
of successful experience in utilization, quality review and
quality improvement. More than 16 years ago, dedicated individuals
formed the parent organization, Louisiana Health Care Review,
Inc. Founding LHCR management and staff dedicated themselves to
improving the process of utilization review. Currently, HSI and
its sister organizations provide Medicare and Medicaid peer review
in three states.
HSI's effective, team-based management, continuous
improvement methods and high-tech solutions - such as online review - provide excellent results, achieving
nearly 100 percent timeliness in review and notification and
providing true peer-to-peer medical review.