Important Update to Medicaid Prior Authorization Processes Effective Feb. 1, 2027
Nov. 11, 2026
Effective Feb. 1, 2027, Blue Cross and Blue Shield of Illinois will discontinue issuing courtesy prior authorizations for services that do not require authorization under applicable benefit plans, regulatory requirements, contractual provisions or clinical policies. This change will simplify administrative requirements and provide greater clarity regarding services that require prior authorization for members with Blue Cross Community Health PlansSM.
What this means for you
Effective Feb. 1, 2027:
- Providers should no longer submit courtesy prior authorization requests for services that do not require authorization for BCBSIL members with BCCHPSM. Instead, providers should render covered services, as appropriate, and submit claims through established billing processes.
- Providers must continue to obtain prior authorization for services where authorization is required under existing policies, benefit plans or applicable requirements.
- Providers should continue using existing BCBSIL authorization resources, provider portal tools and established provider support channels to determine whether authorization is required before rendering services.
What’s not changing?
This update does not change existing prior authorization requirements, covered benefits, medical necessity criteria, claims submission guidelines or applicable reimbursement policies.
Additionally, member rights, provider appeal rights and all applicable regulatory and contractual requirements remain unchanged.
Learn more about prior authorization.
Frequently asked questions
What line of business does this apply to?
This is for BCCHP only.
Why is BCBSIL discontinuing courtesy prior authorizations?
Courtesy prior authorizations are sometimes requested for services that do not require authorization. Eliminating these unnecessary requests helps reduce administrative burden, streamline processes and improve consistency in communicating authorization requirements.
How can I determine whether a service requires prior authorization?
Providers should continue to reference existing BCBSIL authorization resources and utilize established provider support channels to verify authorization requirements.
What if I need confirmation that prior authorization is not required?
Providers should use existing authorization verification resources and provider support channels. Additional guidance regarding documentation of services that do not require prior authorization will be communicated as available.
Will this change impact claims processing or reimbursement?
This change applies specifically to courtesy prior authorization requests for BCBSIL members with BCCHP. Claims must continue to be submitted and will be processed in accordance with applicable benefit plans, billing guidelines and reimbursement policies. The absence of a prior authorization requirement does not guarantee payment.
Is any action required?
We encourage you to review your current authorization submission processes and ensure that requests are submitted only for services requiring prior authorization. Please share this information with staff responsible for scheduling, authorization submissions and billing.
BCBSIL appreciates your continued partnership and commitment to providing quality care to our members. Thank you for your cooperation as we work to simplify administrative processes and improve the provider experience.