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Prior Authorization/ Referral

The recently passed Prior Authorization Reform Act is helping us make our services even better. This bill takes effect January 1, 2022.

Our prior authorization (PA) process will see many improvements. We will be more clear with processes. And we will reduce wait times for things like tests or surgeries. You will also see improved fairness with our PA process.

Our current PA process is NCQA certified. It meets many of the new law's standards. However, we see this as a time to continue improving our services.

For clinical criteria, please see the information linked below. To request PA information or receive additional support, please contact us at memberservices.il@mhplan.com or 866-606-3700 (TTY: 711).

Do I need a referral to see a specialist?

No, you do not need a referral from your PCP to see a specialist. You do not need a referral for routine vision care, chiropractic services, or mental health/counseling services.