IllinicarePre-Auth Needed?
Our convenient code look up tool will instantly let you know if you need a pre-authorization for a specific procedure, medication or revenue code.
If an authorization is required for the requested procedure, to submit an authorization Login here.
**Please note, effective 1/25/2013, Cenpatico still requires prior authorizations for certain behavioral health services. Click here to see prior authorization guidelines for behavioral health.**
Out-of-network providers must submit a pre-authorization for all procedures. Join Our Network
Please note: Certain services may not be covered. Please refer to the state specific benefit coverage and limitations, including behavioral health and long term care services, age/diagnosis-specific authorization requirements, and self-referral services.
| Behavioral Health, Dental, Vision, and High Tech Radiology | |
|---|---|
| Please contact the IlliniCare Health Plan for Pre-Authorization requirements. | |
| Type of service | Authorization Required? |
| Emergency Room and Urgent Care Services | NO |
| Home locations (04,12,13,14,16,33,99) | YES |
| Dialysis services | NO |
| FQHC, DOH, and RHC | NO |
| Family Planning services billed with a V25 through V25.9 diagnosis | NO |
| Hospice services | YES |
| Plastic surgeon services rendered in an office setting | YES |
| Podiatry services rendered in an office setting allow three visits and then require pre-authorization | Maybe |
| Inpatient confinements require pre-authorization | YES |
| All elective services arranged by or provided by a non-participating provider | YES |
Disclaimer: Code validation is not a guarantee of payment.