Medicaid Prior Authorization Change Summary in Effect as of December 1, 2024

Date: 09/25/24

YouthCare HealthChoice Illinois (YouthCare) requires prior authorization (PA) as a condition of payment for many services. This notice contains information regarding such prior authorization requirements and is applicable to all Medicaid products offered by YouthCare.

YouthCare is committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.

Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. Non-contracted providers and facilities require authorization for all services except where indicated.

For complete CPT/HCPCS code listing, please see our Online Prior Authorization Tool.

Effective December 1, 2024, the following are changes to prior authorization requirements:

IL Medicaid Prior Authorization Change Summary

Service Categories Include:

Cardiovascular, Drug Codes, Durable Medical Equipment, Gastroenterology, Genetic Analysis, Genitourinary Procedures, Hearing Services, Home Services, Laboratory, Medical Supplies, Other Medical Services, Pain Management, Physical Medicine, Physician Services, Sleep Medicine, Stereotactic Radiosurgery, Surgery Procedures, Transplant Services, Vision Services.

If you have questions, please call YouthCare Provider Services at 844-289-2264, Monday through Friday from 8 a.m. to 5 p.m., or contact your Provider Engagement Administrator.