MedicaidPrior AuthHigh impact
Medicaid Reminder: Know When To Request Post Acute Care Authorizations
BCBS Illinois·IL·Government Programs
We identified it
Sep 5, 2026
Summary
Blue Cross Community Health Plans (BCCHP) Medicaid now requires providers to request prior authorization for post-acute care facility admissions no more than three days prior to admission, rather than earlier timeframes. This change reflects the plan's requirement to account for rapidly changing health conditions and medical necessity. Billing teams must update their prior authorization submission workflows to align with this three-day window.
Action Required
Immediately: Billing and clinical staff must update prior authorization request procedures for all Blue Cross Community Health Plans (BCCHP) Medicaid members. (1) Modify billing system workflows to flag post-acute care admissions and ensure prior authorization requests are submitted no earlier than three days before admission. (2) Update provider encounter forms and checklists to remind clinical staff of the three-day submission window. (3) Train front desk and scheduling staff to coordinate timing of prior authorization requests with admission dates to comply with the three-day requirement. (4) Continue to verify eligibility and benefits through Availity Essentials or preferred vendor before rendering services to confirm current prior authorization requirements. (5) Document the submission date and admission date on all post-acute care prior authorization requests. Failure to submit prior authorizations within this timeframe may result in claim denials or delayed authorization processing, and submitting too early (more than three days prior) may require resubmission.