February 2026 Top of Mind

Initial prior auth not required for certain services in 2026

Recent updates under Illinois House Bill 3019 include prior authorization exemptions and notification requirements for certain medically necessary services. The updates apply to Fully Insured Behavioral Commercial, Non-ERISA Administrative Services Only members.

What’s changing

The IL HB 3019 mandate brings important changes to prior authorization and notification requirements for mental health, pregnancy/postpartum and substance use disorder services. Please review the details below to ensure your workflows remain compliant and efficient.

• Prior authorization is now prohibited for the initial period of treatment (varies by level of care and setting).
• Notification requirements have been standardized — providers must now notify insurers within a set timeframe after treatment begins.
• Concurrent review starts after the initial no-auth period.
• Outpatient, intensive outpatient, partial hospital program and residential services now have clear timelines for notification and review.
• Pregnancy/postpartum care^* and autism spectrum disorder services also benefit from reduced prior authorization requirements.

*Note: If you’re submitting a claim for a member who is pregnant or postpartum, one of the following should be billed as the primary diagnosis:

• O99310-099315
• O99320-O99325
• O99330-O99335
• O99340-O99345
• F530 or F531

Questions?

Please call the number on the back of the member’s ID card.