MedicaidPrior AuthHigh impact
Prior Approval for Children’s Physical and Occupational Therapy Services Effective with Dates of Service Beginning November 16, 2015
Illinois Medicaid - HFS·IL · Physical Therapy, Occupational Therapy, Pediatrics·Provider Notice
Effective date
Nov 16, 2015
We identified it
Jun 20, 2026
Summary
Starting November 16, 2015, Illinois Medicaid requires prior authorization for all physical and occupational therapy services for children through age 20. Providers must submit specific forms including HFS 3701T, practitioner orders, and evaluations before providing services.
Action Required
Before November 16, 2015: Billing team and therapy providers must implement prior authorization process for all pediatric physical and occupational therapy services. Submit HFS 3701T form, practitioner orders, and initial evaluations to fax 217-524-0099. Verify patient eligibility before each service. Update workflow to check if patients are in MCO/MCCN plans (which require separate plan-specific prior auth). Failure to obtain prior authorization will result in claim denials for Illinois Medicaid patients.