Criteria Set Change for EviCore – Effective 2/1/2026

UPDATE Nursing Home Admission Notification and Authorization

Prior Authorization Changes Effective 12/19/2025

Leqvio (inclisiran) Benefit Transition Effective December 1, 2025

Changes Made to Prior Authorization Look-Up Tool: Effective Immediately

Provider Lunch & Learn: Nursing Home Admission Notification & Authorization

Provider Lunch & Learn: Home Therapy Prior Authorization Changes Effective 9/1/2025

Provider Lunch & Learn: Utilization Management

Prior Authorization Changes Effective 10/08/2025

Expansion of Clinical Automatic Prior Authorization Criteria for Orthodontic Services_8.1.25

Nursing Home Admission Notification and Authorization – Effective 10/1/2025

Procedure Codes Prior Authorization Changes Effective 10/1/2025

Prohibition of Bot Users on the CountyCare Provider Portal

Home Therapy Prior Authorization (PA) Changes Effective 09/01/25

Recommend CountyCare to Your Medicaid Patients – Here’s Why

Provider Lunch & Learn: Provider Orientation

Update: Change Healthcare Cybersecurity Breach

Provider Lunch & Learn: IAMHP Universal Roster + Access and Availability Standards

UPDATE: ER Claims Coding Consistency Policy

Prior Authorization (PA) Change effective 4/1/25

Provider Lunch and Learn- Health Equity

2025 Annual Notice for CountyCare Providers

Preferred Drug List — Formulary Update

Emergency Room Claims Coding Consistency Policy

Prior Authorization Changes Effective 05/23/2025

Prior Authorization Change Effective 1/22/25

Updated Provider Manual

Prior Authorization Change Effective April 5 2025

Procedure Codes Added to the Prior Authorization List Effective April 2025

Advanced Imaging and Cardiology Authorization Changes

Musculoskeletal Surgery and Interventional Pain Management Authorization Changes

Physical Occupational and Speech Therapy Services Authorization Changes

Behavioral Health (BH) Administrative Day Authorization Support Effective 02/24/25

CountyCare Rewards and Benefit Updates

Prior Auth Change — Medications on the Medical Benefit — Effective 3/1/2025

Prior Auth Change — Evolent Specialty Services — Effective 3/1/2025

Early Delivery Protocol Updated — Effective 11/1/2024

Optum Pre-Payment Review Program

Procedure Codes Removed from Prior Authorization List- Effective January 1 2025

SUPR Expanded Services Program Effective 12/1/2024

Climate Change

Evicore

2024 Vaccine Updates

Provider Town Hall

Attention CountyCare Providers — Medicaid Provider Revalidation

Prior Authorization Changes Effective 11/26/2024

Postpartum Bonus Payments

Provider Lunch & Learn — Utilization Management

Updated CountyCare Network Management Team

Provider Lunch & Learn- IAMHP Universal Roster Training

CrowdStrike Global Outage

Procedure Codes Removed from Prior Authorization Look-Up Tool

APR-DRG Billing Clarification

Non-Emergency Medical Transportation Transition

Prior Authorization Changes Effective 08/09/2024

CountyCare UM Webinar: Elective Deliveries Policy

Naloxone Utilization

New CountyCare Partnerships

Living Well Program

SUPR Services Notification Requirements

Prior Authorization Changes- Effective 6/17/24

Measles and Flu Vaccinations: Identifying Care Gaps

Endodontic Benefit Expansion

Change Healthcare Cybersecurity Breach

Prior Authorization DME Changes- Update

Enhanced Respiratory Care (ERC) Program Update- Referral Process

Prior Authorization Changes Effective 2/22/2024

Prior Authorization Changes

Newborn Eligibility and Authorizations Update

Update to Prior Authorization (PA) Look-Up Tool

CountyCare Eventa Training

New EDI Edits and Billing Clarification for Inpatient Claims

New EDI Edits and Billing Clarification for FQHC Claims

New Member Population January 2024

2024 Annual Provider Notice

Updated Notice December 2023 -Change in payment for early elective deliveries effective October 3 2022

Progeny Authorizations and Newborn Eligibility Update

IAMHP Universal Roster Training

Prior Authorization Changes for 2024 effective 01/10/2024

Cambio en los criterios utilizados para la aprobación de la cirugía bariátrica

Vaccines: COVID-19 RSV & Influenza

Programa de capacitación de eviCore para cambios de autorización previa vigente a partir del 1/11/23

Gestión de la utilización de recién nacidos en cuidados intensivos neonatales

Revisiones de los beneficios de la Corona de Illinois de CountyCare Health Plan vigentes a partir del 15/11/2023

eviCore para gestionar solicitudes de autorización de equipos médicos duraderos

Revisiones de beneficios parciales para adultos de CountyCare Health Plan Illinois vigentes a partir del 1 de octubre de 2023

Autorización previa electrónica (ePA)

Nuevo programa para mejorar los resultados del paciente respiratorio complejo: efectivo a partir del 16/10/23

Encuesta de Satisfacción de Proveedores

Reclamación de referencia requerida en la presentación de reclamación corregida

Política Administrativa del Hospital

Cambios en la autorización previa a partir del 12 de septiembre de 2023

Change in Authorization for Newborn Admissions Effective September 13 2023

Illinois Preferred Drug List — Formulary Update

Eliminación de autorización previa de medicamentos contra la hepatitis C

Actualización de beneficios de la vista

Revisiones de beneficios de ortodoncia para adultos

Aviso del proveedor Cambio en el administrador de beneficios de farmacia (PBM)

Partos Electivos Fase 2

Actualización de admisión de múltiples lugares de servicio (POS)

Actualizado: Equipo de administración de la red de CountyCare

Solicitudes de autorización previa para trasplantes de pulmón y lóbulos

Cambios en la autorización previa 2023

Cambios en la preservación de la fertilidad

Actualización de codificación 2023 ICD-10

Capacitaciones de la lista universal de IAMHP

Aviso anual para proveedores de 2023

Actualización de la política de revisión de utilización: Autorización para observación versus nivel de atención para pacientes internados

Solicitudes de extensión de UM para autorizaciones previas

Aviso anual para proveedores de 2022

REVISADO: Actualizaciones del formulario de 2023

Requisitos de facturación actuales para el tratamiento con oxígeno hiperbárico (HBO)

Cambios en la autorización previa para 2023

Actualización del Departamento de Relaciones con los Proveedores

Actualizaciones del formulario 2023

Actualización de puerta de enlace EDI: disponibilidad

SMART Act Authorization Changes Effective October 31 2022

Actualizaciones de la lista de PCP para obstetras/ginecólogos y pediatría

Updated Notice: Change in Payment for Elective Deliveries Effective October 3 2022

Change in Payment for Elective Deliveries Effective Oct. 3 2022

ACTUALIZADO: Observación versus nivel de atención para pacientes hospitalizados

FQHC Covid-19 Lista de tarifas Actualizaciones de EDI

Admisión y alta del mismo día calendario Reclamos de pacientes hospitalizados Actualizaciones de EDI

Enmienda a los marcos de tiempo de las citas de salud conductual

Observación versus nivel de atención para pacientes hospitalizados

Formulario de Certificado de Servicios de Transporte Nuevos Requisitos

Aviso General: POS 21/22 vs. 23 sobre Reclamos de ER

Guía de facturación de telesalud para proveedores de SUPR

Cambio urgente en el proceso de solicitud de mensajería unificada

Lista de medicamentos preferidos de Illinois: Actualización del formulario

Guía de referencia de medición HEDIS disponible en el sitio web

Sistema de disputas de proveedores y proceso para disputas de readmisiones de 30 días

Notificación de 60 días de cambios de autorización previa

ACTUALIZACIÓN: Cambios en la lista de medicamentos preferidos

CountyCare Peer-to-Peer Review — Update

Códigos de taxonomía requeridos en la presentación de reclamos o el reclamo podría ser rechazado

Mejoras en el portal de proveedores de gestión de utilización

COVID-19 Autorización previa Cambios temporales para centros de enfermería especializada

2021 Annual Provider Notice

Reminder PA Changes Effective 1/1/2022

Important Announcement: Non-Emergent Ambulance Transition Effective 1/1/2022

Car-T Therapy Policy and Procedure

Updated CountyCare Provider Manual

Criteria and Process in Selected Surgical Procedures

Inpatient Readmissions: Reimbursement Policy Effective 7/1/2021

CountyCare Drug List — Update

Guía de residuos de vacunas COVID-19 para proveedores

Capacitación para la certificación del programa empresarial empresarial para proveedores

ACTION REQUIRED: Provider Roster Required Fields

Reanudación de la presentación oportuna a partir del 1 de junio de 2021

Formulary Updates Effective April 1 2021

Provider Relations Representative Reference — March 2021

COVID-19 Prior Authorization Temporary Changes — Updates

Facturación de la administración y la vacuna COVID-19

Non-Emergent Medical Transportation Ambulance Claims Update — March 2021

Ley de APOYO: nuevas actualizaciones relacionadas con los opioides

COVID-19 Prior Authorization Temporary Changes — Updates — February 2021

Guía de vacunación masiva de COVID-19 para proveedores

Provider Relations Team Notice January 2021

COVID-19 Prior Auth Temporary Changes- UPDATES December 22 2020

2021 Annual PA Changes — (December 2020)

Important Utilization Management Updates — Effective January 1st 2021 — (December 2020)

Human Donor Milk Coverage Provider Notice — December 17 2020

New Population Health Tool in the CountyCare Provider Portal — December 12 2020

Affinitē ProviderLink Quick Reference Guide — December 12 2020

Illinois Preferred Drug List — December 1 2020

Applied Behavior Analysis (ABA) Services Now Covered — November 25 2020

COVID-19 Prior Auth Temporary Changes- UPDATES November 25 2020

Provider Education Webinar: Provider Orientation and Provider Portal Review — November 2020

Policy and Procedure Manual Human Donor Milk — November 2020

Updates Regarding Claims Submission — November 2020

Open Enrollment in Illinois is Approaching — October 2020

Authorization Timelines and Decisions — October 2020

2020 Annual Notice for CountyCare Providers

Prior Authorization Submission Checklist — October 2020

Provider Education Webinar: Home and Community-Based Services (HCBS) Waiver Providers — October 2020

New policy and procedure billing changes for Home and Community-Based Services (HCBS) waiver providers — September 2020

DCFS YouthCare Program Update — September 1 2020

New False Claims Act and Whistleblower Protection Policy — August 2020

Final Reminder — Authorization Reinstatement as of 9/1/20 — August 25 2020

COVID-19 Prior Auth Temporary Changes — August 11 2020

Change to Ordering Referring and Prescribing (ORP) Policy Effective 8/1/2020 — July 2020

COVID-19 Prior Auth Provider Notice — July 2020

Brighter Beginnings — Blood Pressure (BP) — July 2020

ACTION REQUIRED: Your IAMHP Roster is Needed or Your Claims may be Denied — July 2020

CountyCare Stands Ready to Support our Members Provider Partners and the Community During this Time of Unrest — June 5 2020

COVID-19 Prior Auth Temporary Changes — Updates June 2020

Important Utilization Management Updates — June 2020

Prior Auth for Oncology — 2020

New Provider Phone Number for First Transit — May 2020

COVID-19 Hospital Administrative Day Policy — May 2020

Urine Drug Testing UM Update — 2020

Universal Provider Roster — April 2020

COVID-19 Prior Auth Temporary Changes — April 2020

Billing Update related to Mobile Crisis Response — March 2020

Network Criteria for Selected Surgical Procedures — February 2020

Special Needs Children (SNC) Program Updates — February 2020

IMPORTANT UTILIZATION MANAGEMENT UPDATES — January 2020

IMPACT Provider Letter — December 23 2019

Important Update: Ordering Referring Prescribing (ORP) — January 2020

Nursing Facility Provider Notice — January 2 2020

Important Update: Ordering Referring Prescribing (ORP) National Provider Identifier (NPI) Requirements — December 2019

Vision Providers Continuity of Care Extension — December 2019

Mobile Crisis Response Providers

PROVIDER POLICY UPDATE NOTICE: Updates to Prior Authorization Requirements — Hospice Services

2019 Annual Provider Notice

Pharmacy Updates: Prescribing Provider

Pharmacy Updates

Corrected Claims Claim Review Provider Disputes and Medical Necessity Appeals

Provider Notice Stroger Hospital

Important Update related to HCBS Waiver Billing September 2019

Utilization Management Services — Cardiology/Oncology Frequently Asked Questions (FAQs)

New Utilization Management/Quality Program for Oncology Services

New Utilization Management/Quality Program For Cardiology Services

MLTSS Claim Processing Hold

Authorization Portal Enhancement Effective 7/1/2019

Pharmacy Notice: MedImpact Direct Specialty Update

2018 Annual Notice for CountyCare Providers

Provider Relations Team Notice May 2019

Provider Account Inactivity

Important Update to LTC and SLF Prior Authorizations — May 2019

Pharmacy Notice MedImpact Direct Specialty — April 12 2019

CountyCare Has New Dedicated Fax Line for All Reports of Critical Incidents April 1 2019

CountyCare Primary Care Provider Policy Update — April 9 2019

Pharmacy Benefit Manager (PBM) Change March 2019

Transportation Card Distribution Changes March 2019

Bariatric Provider Notice March 2019

UPDATE: Hand Price Code Reimbursement Methodology February 2019

Provider Notice: Important Utilization Management Updates December 2018

Care Plans Now Available in the Provider Portal December 2018

Provider Notice — New Authorization Portal Upgrade Effective 10/8/18 — September 2018

Mailroom Notice: New Mailing Addresses — July 2018

Adoption of the Universal Provider Roster Template July 2018

HCBS Provider Notice: Provider — Care Coordination Communication

Waiver Provider Billing Update Notice May 2018

Provider Portal Training Sessions April 20 2018

Provider Portal Upgrade Notice April 2018

New Electronic Funds Transfer (EFT) and Electronic Rremittance Advice (ERA) 4/8/2018

New Prior Authorization Forms 2/5/2018

Nursing Facility Provider Notice January 2018

HCBS Provider Notice: Authorization Changes for Waiver Services

CountyCare Provider SMART Notice December 2017

CountyCare Cigna Member Transition Notice 8/1/2017

CountyCare Care Coordination Referrals 6/19/2017

CountyCare Prior Authorization Updates Notice 4/1/2017

CountyCare BH Service Notice 12/29/2016

CountyCare Behavioral Health FAQs 11/29/2016

CountyCare Direct Credentialing Notice 10/14/2016

CountyCare BH OON Provider Notice 9/30/2016

CountyCare Advocate Health Systems Notice August 2016

CountyCare Provider Credentialing Notice 8/18/2016

Provider Delegated Credentialing Notice 8/18/2016

CountyCare CABG Oncology Provider Notice 8/16/2016