January 2026

New Year, New Claims—Billing Is Here!

A Holiday Edition for Illinois Public Health Partners

January is here, bringing chilly temperatures, shorter days, and the height of cold and flu season. As public health activity ramps up, it’s the perfect time to refocus, refresh processes, and make sure billing operations are ready for the demands of the new year. In this edition of the Third-Party Billing Digest, we’re sharing timely reminders, helpful updates, and practical tips to help you stay organized and efficient during this busy winter season. So, bundle up, grab something warm, and let’s kick off the year strong.

Molina Healthcare of Illinois (Molina) reminds providers that they are statutorily required by the Department of Healthcare and Family Services (HFS) to submit monthly rosters for the purpose of data accuracy. The Illinois Association of Medicaid Health Plans (IAMHP) is releasing an updated universal roster template on February 1, 2026. IAMHP is your go-to source for the template, along with education and resources related to provider rosters. To learn more about this change, please find a link to Molina notification here.

Transitioning to Digital-Only Prior Authorization (PA)

Molina Healthcare of Illinois (Molina) is committed to serving providers in the most efficient and transparent ways possible while also adhering to a regulatory landscape that is pushing toward faster, more streamlined Utilization Management (UM) processes. To achieve this, Molina will transition to a Digital-Only Prior Authorization Model via Availity and will no longer accept faxes after January 31, 2026. As of February 1, 2026, authorization requests must be submitted through Availity. To learn more or to register click here.

Medicaid Billing: Noncovered Diagnosis Codes

Molina Healthcare of Illinois (Molina) reminds providers that, in accordance with HFS guidelines, Medicaid claims containing any combination of the following diagnosis codes will be denied. Click here to review the Medicaid Noncovered Diagnosis Codes. 

The Department of Healthcare and Family Services (HFS) will allow the maximum dispensing of a 12-month supply at once of contraceptives. Beginning January 1, 2026, in accordance with Public Act 099-0672. This includes prescription and over the counter (OTC) contraceptive drugs, devices, and products approved by the United States Food and Drug Administration (FDA), excluding male condoms. To learn more about this update, please see the Molina notification found here.

Integrating Harm Reduction into Health Care Settings Serving Medicaid Members Medicaid plays a major role in covering health care for people with substance use disorder (SUD), including those who use drugs or alcohol or are in recovery, and is uniquely positioned to expand access to culturally and linguistically appropriate, evidence-based SUD services such as harm reduction. This brief explores how states and health care organizations can integrate and sustain harm reduction within settings that serve Medicaid beneficiaries and other populations, with the goal of improving health outcomes while reducing health care costs. Read the brief

Changes to Childhood Immunization Schedule: The Acting Director of the Centers for Disease Control and Prevention (CDC) signed a memorandum on January 5, 2026, to change the U.S. childhood immunization practices, reducing the number of universally recommended vaccines (e.g., removing flu and COVID-19 vaccines for most children) and making others subject to "shared clinical decision making". This has prompted significant concern from public health associations including IPHA and the American Public Health Association (APHA) about the risk to children from vaccine-preventable diseases. IDPH posted that the "science hasn't changed, evidence continues to support the full childhood vaccination schedule." In addition, the Vaccines for Children (VFC) Program and private insurers will continue to cover all recommended childhood vaccines, ensuring access for all eligible families 

The Illinois Department of Healthcare and Family Services (HFS) is launching new coverage for home visiting services for pregnant and parenting Medicaid customers, effective November 21. The newly-covered services and supports aim to meet the needs of pregnant and parenting individuals at a critical time in their healthcare journey, in order to create better health outcomes for both parents and their children. Click to view press release.

Molina Health Care of Illinois invites you to join the upcoming live webinars:

FQHC, RHC, Encounter Clinic Billing  |  January 22  |  1:00 PM  |  Register

Dental Provider Training  |  January 22  |  2:30 PM  |  Register

HCBS and Home Health Billing  |  January 27  |  1:00 PM  |  Register

Utilization Management Processes  |  January 28  |  1:00 PM  |  Register

Dental Provider Training  |  January 29  |  10:30 AM  |  Register

• Looking for something else? Explore the 2025 schedule of live webinars exclusively for Illinois providers. Meanwhile, register for provider updates to receive notices for upcoming sessions.

Lactation Consultant Billing  |  February 3   |   1:00 PM  |   Register

Dental Provider Training  |  February 5  |  10:30 AM  |  Register

Molina Health Care of Illinois invites all Illinois dental providers and staff to join its free, one-hour Provider Education Series webinars. These sessions provide an overview of Molina’s Medicaid and D-SNP dental plans through SKYGEN, highlighting resources, and answer frequently asked questions. Training is led by your dedicated Molina Dental Senior Provider Services Representative. Click here to see the full list of 2026 webinars and register.

Illinois Rural Health Association invites you to join an upcoming live webinar on February 3, 2026, from 3:00–4:00 PM CT. This session will feature Brock Slabach, Chief Operating Officer of the National Rural Health Association, who will share the latest federal policy updates and insights from Washington, D.C., and discuss how these developments may impact rural health communities. Click here to register

National Government Services is hosting weekly training sessions on Medicare Part B. These sessions are designed to support providers and organizations by offering guidance on Medicare Part B coverage, billing requirements, updates, and common compliance considerations. Trainings are led by subject matter experts and provide valuable opportunities to enhance understanding and stay current with Medicare policies. To view the full list of upcoming training sessions and register, please click the link.

Triage Cancer is hosting a free webinar series reviewing the 2026 federal budget and funding outlook, highlighting potential impacts on individuals with serious or chronic medical conditions and on the health care system in the months ahead.

To Register and watch recordings of past webinars please click here.  

Meridian is pleased to announce additional Wellcare by Meridian sessions to support your transition to the Dual Eligible Special Needs Plan (D-SNP) program. These orientation sessions are designed for both existing and newly contracted Wellcare providers. They will cover key topics, including member benefits, billing and payment processes, and essential information for serving Wellcare members.

These sessions will help ensure you are fully prepared to deliver exceptional care under the D-SNP program. Please register below:

• January 22, 12 – 1 PM
• February 5, 12 – 1 PM
• February 19, 12- 1 PM

Aetna Better Health of Illinois

Aetna Better Health® of Illinois has updated its Utilization Management processes to comply with the Healthcare Protection Act (HPA), as amended by Public Act 104-0028 (2025), effective January 1, 2026. Click here to see the notification requirements

Aetna Better Health® of Illinois is committed to supporting providers with claims-related issues during the redetermination process. This support includes assistance with claims submissions for members during their redetermination window. Click here to see the provider notice.

Contact your Provider Relations representative with any questions.

BlueCross BlueShield of Illinois

BlueCross BlueShield has updated their performance incentive amounts for 2026 for contracted providers participating in the Illinois Medicaid Clinical Measures Incentive Program. Click here to view the updates.

The January 2026 issue of Blue Review is available here. If you have not already subscribed to receive this publication, you may sign up here. 

To contact your Provider Network Consultant, visit Provider Network Consultant Assignments for more information.

Humana

Requirements for the 2026 prior authorization and notification lists (PALs) are now available. Click here to review Illinois Prior Authorization and Notification List.

The Q4 2025 issue of Humana Physician News is available here. If you have not already subscribed to receive publications from Humana, you may sign up here.

Meridian

Launching January 1, 2026, Meridian will introduce Wellcare Meridian Dual Align (HMO D-SNP), a fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) designed for individuals who qualify for both Medicare and Medicaid. As part of Illinois’ transition to this integrated model of care and benefits, the current Meridian Medicare-Medicaid Plan (MMP) will end on December 31, 2025. Click here to find the Provider updates.

Monthly Provider Check-In can be found here.

Contact your assigned Provider Engagement Administrator or representative for support. For those without an assigned representative, complete this intake form or contact Meridian using the information here.

To see the complete list of 2026 trainings please click here.

Molina

Molina is sharing a summary of recent news pertinent to your practice/facility. Memo topics include: Rate/Fee Schedule Updates for January, Updates to Molina Clinical Policies, and much more! You can find the ‘Memo Roundup’ here.

Click here to see Molina Healthcare Fourth Quarter Provider Newsletter

To register for Illinois provider updates, so you don’t miss any bulletins, Click Here.

Contact your dedicated Provider Relations Manager or email the Provider Relations team at MHILProviderNetworkManagement@MolinaHealthcare.com. To help identify your dedicated Provider Relations Manager, visit Molina's Service Area map.

United Healthcare

The January 2026 issue of Network News contains important notifications and updates for healthcare providers.  

The January 2026 Reimbursement Policy Update can be found here.

The News Your Way feature allows you to customize your subscription to receive information and updates specific to your role, specialty, and state. Click here to subscribe or update your preferences.