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BCBS IllinoisCommercial · Prior Auth · Prior Authorization · IL · PsychiatryHigh impact

Behavioral Health Utilization Management Program Changes

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jun 16, 2026

Summary

Illinois providers must follow new behavioral health utilization management requirements effective Jan 1, 2026, with no prior authorization needed for initial periods (72 hours for inpatient, 48 hours for intensive outpatient, 2 business days for other outpatient). Notification requirements and timelines differ between commercial and Medicaid members.

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What to do

by Jan 1, 2026 · 3 steps
01Billing team must update prior authorization workflows to exclude first 72 hours for inpatient behavioral health, first 48 hours for intensive outpatient/partial hospitalization, and first 2 business days for outpatient behavioral health services.
02Train staff on notification requirements: 48 hours for commercial inpatient admissions, 24 hours for Medicaid services.
03Update billing system to track first treatment dates for outpatient services to determine coverage periods.
If missed: Failure to provide first treatment date will trigger medical record requests.

Original notice

Behavioral Health Utilization Management Program Changes
bcbsil.com · Always check the source before changing claims.
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