MedicaidPrior AuthMedium impact
Durable Medical Equipment (DME) Prior Approval Process with Transition from Managed Care Organization (MCO) to Healthcare and Family Services (HFS)
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
May 18, 2017
We identified it
Jun 20, 2026
Summary
Illinois Healthcare and Family Services (HFS) clarified requirements for DME prior authorization requests when Medicaid patients transition from managed care organizations to fee-for-service. Providers must submit specific documentation including delivery dates, original practitioner orders, and medical necessity documentation to avoid processing delays.
Action Required
Immediately: For Illinois Medicaid DME prior authorizations, billing team must ensure all requests include: HFS1409 form with delivery date in line 21, copy of original practitioner order with signature/date, medical documentation supporting equipment rental, and completed HFS questionnaires. Fax complete requests to 217-524-0099. Verify patient eligibility before dispensing equipment using EDI vendors, AVRS at 800-842-1461, or MEDI system. Incomplete requests will delay processing.