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|
|FQHC, DOH, and RHC||NO|
|Family Planning services billed with a V25 through V25.9 diagnosis||NO|
|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.