Sept. 2, 2025
Beginning Oct. 1, 2025, we’re making changes to some medical policies following guidance from the Illinois Health Care Protection Act.
What you need to know: These medical policy changes will better align our policies with updated guidelines for determining medical necessity and new definitions for clinical review and standards of care.
Where can I find medical policies? Approved, new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.
Always check eligibility and benefits first: Use Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.