For the best experience, please use the Pre-Auth tool in Chrome, Firefox, or Internet Explorer 10 and above.
Please note: May 11, 2023, marked the end of the COVID-19 Public Health Emergency (PHE). As a result, the Illinois Department of Healthcare and Family Services (HFS) has updated prior authorization requirements. Home health care and Durable Medical Equipment (DME) prior authorizations are effective May 11, while physical therapy, speech therapy, and occupational therapy prior authorizations will begin August 1, 2023. For details, please consult the HFS notice.
All attempts are made to provide the most current information on the Pre-Auth Needed Tool. However, this does NOT guarantee payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding, and billing practices. For specific details, please refer to the provider manual. If you are uncertain that prior authorization is needed, please submit a request for an accurate response.
For vision services, see our Vision Benefits Chart (PDF) or refer to the Medicaid pre-auth tool.
Dental services need to be verified by Envolve Dental.
Complex imaging, MRA, MRI, PET, and CT Scans need to be verified by NIA.
Musculoskeletal Services need to be verified by Turning Point.
Oncology/supportive drugs for all members need to be verified by New Century Health.
Speech, Occupational and Physical Therapy need to be verified by NIA. For Chiropractic providers, no authorization is required.
Post-acute facility (SNF, IRF, and LTAC) prior authorizations need to be verified by CareCentrix; Fax 877-250-5290
Services provided by Out-of-Network providers are not covered by the plan. Join Our Network.
Use our tool to see if a pre-authorization is needed. It's quick and easy. If an authorization is needed, you can access our login to submit online.
Pre-Auth Check Tool – Ambetter | Medicaid | Medicare-Medicaid
Our most up-to-date list of PA codes will be posted on July 1, 2022. Please use our Pre-Auth Check tool.