Updated Service Authorization Program Information: Provider website changes to clarify authorization procedures and requirements

Date: 01/01/26

Meridian’s service authorization program ensures that services provided to members adhere to evidence-based clinical guidelines and conform to health plan benefits.

To better support providers, we have published detailed information on utilization management (UM) policies and procedures in alignment with the State of Illinois regulation: Section 140.76.

Website Updates Include

• Meridian’s Service Authorization Program page outlines key components, including pre-service review (prior authorization), concurrent review, retrospective review, and peer-to-peer review.
  
  Learn more about:
  
  • Meridian’s Prior Auth Check Tool
  • Facility admission guidance
  • Behavioral health notification requirements
  • Administrative days and the procedure to request them
  • Peer-to-peer discussion procedures
  • Evidence-based clinical guidelines used to determine medical necessity
• The Appeals and External Independent Review (EIR) page describes procedures for appeals to an adverse benefit determination and outlines members’ rights to request EIR
• The Service Authorization Program Glossary page lists commonly used terms and definitions

For questions, contact Provider Services at 866-606-3700 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m.