MedicaidPrior AuthMedium impact
Prior Approval Information
Illinois Medicaid - HFS·IL · Dermatology, Wound Care, Pain Management +2 more·Provider Notice
Effective date
Nov 15, 2001
We identified it
Jun 21, 2026
Summary
Illinois Medicaid implemented new prior authorization requirements for three topical medications: Santyl ointment (for wound debridement), Bactroban (for patients 21+), and Lidoderm patches (for post-herpetic neuralgia only). All requests must include specific medical documentation and diagnosis confirmation.
Action Required
By November 15, 2001: Billing team must update Illinois Medicaid claims processing to require prior authorization for Santyl ointment, Bactroban cream/ointment (patients 21+), and Lidoderm patches. Providers must document specific medical necessity including diagnosis, wound size, treatment duration, and infection status for wound care products. Update encounter forms to remind providers of documentation requirements. Claims without proper prior authorization will be denied.