Some services require prior authorization from CountyCare for reimbursement to be issued to the provider.
Questions? View our FAQs or call the CountyCare Medical Management and Prior Authorization Department at 312-864-8200 / 855-444-1661.
The reports below provide an overview of prior authorization data for the previous calendar year for CountyCare members. This report includes statistical information associated with total number of prior authorization requests received (e.g., approvals, denials, and top five reasons for denial).
Prior Authorization Statistical Data 2022
For efficiency and easier tracking, submit your Medical Prior Authorization request through the CountyCare Provider Portal. Click here to login and learn more.
Medical Prior Authorization requests can also be submitted by faxing the Inpatient Prior Authorization Form or Outpatient Prior Authorization Form to:
For Medical Oncology (adult), Cardiology, Radiology or Radiology Oncology authorization requests:
Treatment request forms:
For efficiency and easier tracking, submit your Behavioral Health Prior Authorization request through the CountyCare Provider Portal. Click here to login and learn more.
Behavioral Health Prior Authorization requests can also be submitted by faxing the Behavioral Health Authorization Form to:
CountyCare maintains a Preferred Drug List (PDL), the same PDL as Illinois Medicaid and all Medicaid Health Plans in Illinois. The CountyCare PDL includes a wide variety of generic and brand name drugs. Clinicians are encouraged to prescribe from the CountyCare PDL for their patients who are members of CountyCare.
CountyCare works with CVS Caremark to administer pharmacy benefits, including the pharmacy prior authorization process. CountyCare requires prior authorization for select drugs on the PDL as well as ALL drugs not on the PDL. The PDL indicates which drugs require prior authorization. Most specialty drugs are not on the PDL and require prior authorization as described below.
Follow these steps for efficient processing of your pharmacy prior authorization requests:
Criteria for medication coverage:
To submit a specialty pharmacy prior authorization, complete the Medication Request Form.
Fax all completed forms to CVS Caremark at 1-866-255-7569.
To submit a dental prior authorization, Login Here or call 866-337-1594
To refer to the CountyCare dental benefits, click here.
To submit a vision prior authorization, login here or call 866-337-1596.
To view clinical criteria for prior authorization, click here.
Our Member Services department is ready to help you get the most from your health plan.
Member Services Phone Number:
312-864-8200
855-444-1661 (toll-free)
711 (TDD/TTY)
Hours of Operation:
Monday – Friday: 8:00 AM to 6:00 PM
Saturday: 9:00 AM to 1:00 PM
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