Welcome to  HealthSystems of Illinois
The Medicaid Peer Review Organization (PRO) Quality Assurance and
Utilization Review Program for the state of Illinois



About HealthSystems of Illinois (HSI)



About HSI

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.

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Our Pledge

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

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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.

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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 system.
     

  • 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.

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Provider Services

  • Provider education on HSI services and procedures
  • Medicaid review for:
    • Admissions
    • Concurrent/Continued Stay
    • Coding/DRG validation
    • Retrospective pre- and post- payment
  • Telephonic, on-site and Web-based interactions
  • Quality improvement program
  • Focused studies
  • Trending analysis - utilization, coding/DRG, quality and billing practices
  • External quality review oversight for managed care organizations

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HSI Resources

  • Medical Director and Associates
  • Project Manager
  • Utilization Review Supervisors
  • Quality Assurance Supervisors
  • Utilization/Quality Review Nurses
  • Coding Specialists
  • Data Management
  • Statisticians
  • Administration/Office Support
  • Accounting
  • Communications/Education

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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.

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This Web site is produced by HealthSystems of Illinois, under contract with the Illinois Department of Healthcare and Family Services.
HealthSystems of Illinois 2002  Reports

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