All out-of-network and out-of-state services require prior authorization except for Emergency Care and Family Planning Services.
Some services require prior authorization from CountyCare for reimbursement to be issued to the provider.
Questions? 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).
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:
- Inpatient Prior Authorization: 1-800-856-9434
- Outpatient Prior Authorization: 1-866-209-3703
For Medical Oncology (adult), Cardiology, Radiology or Radiology Oncology authorization requests:
- Call: 888-999-7713 (option 1)
- Fax: 702-726-5186
- Click here to visit the New Century Provider online portal.
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:
- Behavioral Health Authorization: 1-800-498-8217
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 MedImpact 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:
- Complete the MedImpact form: Medication Request Form. Include detailed clinical information that will help MedImpact understand the need for the drug being requested.
- Fax to MedImpact at 858-790-7100.
- Once approved, MedImpact notifies the prescriber by fax and member by letter.
- For urgent or after-hours requests, a pharmacy can provide up to a 72-hour supply of most medications by calling the MedImpact Pharmacy Help Desk at: 888-402-1982.
- All pharmacy prior authorization requests for CountyCare members should be submitted to MedImpact.
Criteria for medication coverage:
To submit a specialty pharmacy prior authorization, complete the Medication Request Form.
Fax all completed forms to MedImpact at 858-790-7100.
To submit a dental prior authorization, Login Here or call 866-337-1594
To refer to the CountyCare dental benefits, click here.