Oct. 1, 2025
The Illinois Health Care Protection Act establishes new requirements, effective Jan. 1, 2026, regarding utilization management and notification of behavioral health treatment.
Following are the new utilization management requirements:
For commercial members and dates of service beginning Jan. 1, there will be no review for behavioral health levels of care as follows:
- No review for the first 72 hours for inpatient mental health, Inpatient detox, inpatient substance use or residential substance use
- No review during the first 48 hours for partial hospitalization
- No review during the first two business days for other outpatient behavioral health treatment: Transcranial Magnetic Stimulation, Electroconvulsive Therapy and psychological testing
Preservice reviews may be required after the “no review” period.
For our members with Blue Cross Community Health PlansSM and for dates of service beginning Jan. 1:
- For inpatient behavioral health care, providers should notify Blue Cross and Blue Shield of Illinois within 48 hours of admission: if notification requirements are met, utilization review won’t be initiated for the first 72 hours of the admission.
- For substance use residential treatment, providers should notify us within 24 hours of initiation of services. Utilization review may begin after the 24 hour notification period.
- For outpatient behavioral health care, including partial hospitalization and intensive outpatient treatment, providers should notify us within 24 hours of initiation of services. Utilization review may begin after the 24 hour notification period.
How to notify us: Continue to submit notification of admissions or initiation of treatment using your current method of seeking authorization.
If coverage is denied retrospectively, neither BCBSIL nor the participating provider shall bill, and the insured shall not be liable, for any treatment through the date the adverse determination is issued, other than any copayment, coinsurance or deductible for the stay through that date as applicable under the policy.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services regarding third party vendors and the products and services they offer.