MedicaidPrior AuthMedium impact
Specialized Prior Approval form for Synagis requests
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, Pulmonology·Provider Notice
Effective date
Aug 19, 2005
We identified it
Jun 21, 2026
Summary
Illinois Department of Healthcare and Family Services has implemented a new specialized prior approval form specifically for Synagis (RSV prevention medication) requests. All strengths of Synagis now require prior approval for the 2005-2006 RSV season, and providers must use the new form available on the state website.
Action Required
Before October 2005: Providers must obtain and use the new specialized Synagis prior approval form available at illinois.gov/hfs for all Synagis requests. Submit completed forms via fax to 217-524-7264. All strengths of Synagis require prior approval for the 2005-2006 RSV season. Contact Pam Bunch at 217-524-7478 with questions about the form.