MedicaidPrior AuthHigh impact
Utilization Review – Prior Authorization Review for Coronary Artery Bypass Graft and Back Surgery Procedures
Illinois Medicaid - HFS·IL · Cardiothoracic Surgery, Orthopedics, Neurosurgery +1 more·Provider Notice
Effective date
Apr 1, 2014
We identified it
Jun 20, 2026
Summary
Starting April 1, 2014, Illinois Medicaid requires prior authorization for all elective coronary artery bypass graft (CABG) and back surgery procedures. Hospitals must submit requests 3-30 days before surgery through eQSuite system, and procedures will be denied without approval.
Action Required
By April 1, 2014: Billing team must establish workflow to obtain prior authorization for all elective CABG and back surgery procedures through eQHealth Solutions' eQSuite system. Submit requests 3-30 days before planned procedures. Train staff on new requirements and update scheduling processes. Use Type of Admission '3' on UB-04 claims for approved elective procedures. Claims will be denied with error code G67 without prior authorization.