No images? Click here
September 2026
Fall Into Focus: Your September Third-Party Billing Digest
As we move into fall, September is a great time to refocus on billing practices, payer updates, compliance requirements, and resources that can help your organization stay prepared for the months ahead. This month’s digest highlights important billing guidance, provider updates, upcoming training opportunities, and helpful resources to support accurate billing and continued success. Whether reviewing new requirements, preparing for upcoming changes, or strengthening your team’s billing knowledge, these updates are here to help keep your organization informed and on track this fall.
Change to Recommended Clinical Review Request Process
Effective August 15, 2026, Blue Cross and Blue Shield of Illinois retired the recommended clinical review request process through the Availity® Essentials Attachments tool. Providers should now use Availity Authorizations, the preferred method for submitting recommended clinical review requests. Fax and phone options remain available for providers who do not have online access. For more information, please click here to view the provider
notice.
Digital Access to Medicare Advantage Prior Authorization Decision Letters
Beginning October 10, 2026, providers will be able to access Medicare Advantage Prior Authorization Decision Letters electronically through the Provider Correspondence Viewer in Availity Essentials. Approval letters will no longer be mailed through USPS, while denial letters will continue to be mailed and available electronically. Providers are encouraged to familiarize themselves with the Provider Correspondence Viewer to ensure timely access to authorization decisions. To review the provider notice, please click here.
Medicaid Reminder on Post-Acute Care Authorizations
Blue Cross and Blue Shield of Illinois reminds Medicaid providers when to request authorization for post-acute care services. Providers should review authorization requirements and submit requests when appropriate to help prevent delays in care and potential claim issues. For complete information, please click here to review the provider notice.
Blue Cross and Blue Shield of Illinois: Illinois House Bill Expands In-Network Options for MH/SUD Services
Beginning January 1, 2027, Illinois House Bill 4751 will expand in-network options for mental health and substance use disorder (MH/SUD) services. The legislation establishes new requirements related to network adequacy and access to MH/SUD providers. Providers should review the upcoming changes and consider how they may affect network participation and access to services. For complete information, please click here to review the provider notice.
Molina Healthcare of Illinois: Important Reminder About Readmissions
Molina Healthcare of Illinois is reminding providers of its readmission policies and the importance of accurate documentation and coding when submitting claims for readmissions. Providers should review applicable readmission guidelines to help ensure claims are billed correctly and avoid potential payment issues. Click here for additional information.
Revised CCBHC Billing Guidelines
Molina Healthcare of Illinois has issued revised billing guidelines for Certified Community Behavioral Health Clinic (CCBHC) services. Providers should review the updated guidelines to ensure billing practices and claims submissions align with Molina’s current requirements. Click here to view the provider notice.
Required Regulatory Model of Care Training
Molina Healthcare of Illinois is reminding providers about the required Regulatory Model of Care Training. Providers should complete the required training within the designated timeframe to remain compliant with regulatory requirements. Click here to view the provider notice.
Blue Cross Blue Shield of Illinois: Post-Payment Reviews on Medicaid Claims
Beginning October 2, 2026, Blue Cross Blue Shield of Illinois will conduct post-payment reviews of Medicaid claims to verify billing, coding, and documentation accuracy. Providers selected for review may receive a written request for records and supporting documentation. Providers are encouraged to review their billing and documentation practices now to help ensure claims are accurate and properly supported. Click here for additional information.
Understand Upcoming Medicaid Policy Changes Affecting ACA Adults and Certain Immigrant Populations
Meridian is reminding providers about upcoming federal Medicaid policy changes that may affect certain members beginning October 1, 2026, and January 1, 2027. Beginning January 1, 2027, certain ACA Adult members will be subject to new work requirements and six-month eligibility renewals. HFS began mailing notices to affected ACA Adult enrollees on August 31, 2026. Additional changes affecting eligibility for certain immigrant populations will take effect October 1, 2026. Providers are encouraged to remind Meridian members to keep their contact information current with Illinois Department of Health and Family Services (HFS) and to respond promptly to all notices. Click here to see the provider’s notice.
Blue Cross Blue Shield of Illinois: Coding for Evaluation and Management Claims, September 24 | 1:00-2:30 PM
Blue Cross Blue Shield of Illinois offers a variety of coding webinars designed to help providers stay current on billing and coding requirements, documentation practices, and other coding-related topics. These educational sessions provide an opportunity for providers and billing staff to strengthen their understanding of coding requirements and support accurate claim submission. Click here for more details and register.
Blue Cross and Blue Shield of Illinois: Mandatory BCCHP Annual Provider Training, October 6 and October 20 | 10:00 AM – 12:30 PM
Contracted providers serving Blue Cross Community Health Plans (BCCHP) members are required to complete annual training by December 31, 2026. Providers can fulfill this requirement by attending one of two guided webinars offered in October. The training covers six required modules: Model of Care/Medical Home, Fraud, Waste and Abuse, Abuse, Neglect and Exploitation, Cultural Competency, Americans with Disabilities Act/Independent Living, and Medicare Parts C and D General Compliance Training. To register and learn more follow the links below:
CountyCare: Provider Roster Training, October 13 | 10:00–11:00 AM
This training will provide an overview of CountyCare’s provider roster process and requirements, helping providers understand how to submit and maintain accurate provider information. The session is designed to support accurate provider directories and ensure CountyCare has current information for members and providers. Click here to learn more and to register.
Illinois Department of Healthcare and Family Services HR1 Module 7: System Changes: How to Utilize and Assist, October 21 | 1:30–2:30 PM
The Illinois Department of Healthcare and Family Services (HFS) will continue its HR1 Webinar Series with Module 7, focusing on system changes and how providers can utilize and assist with upcoming Medicaid system updates. This session will provide information to help providers better understand and navigate changes resulting from HR1 implementation. Click here to register and learn more.
Join the Illinois Public Health Association's Help. Guide. Thrive. Lunch & Learn Series for two (2) upcoming educational opportunities designed to support healthcare professionals and strengthen client-centered care:
Speech-Language Pathology Essentials for Community Health Workers, September 18 | 12:00–1:00 PM
This free webinar will introduce Community Health Workers to the role of speech-language pathologists and how they can support adults in the community. Participants will learn about common communication and swallowing disorders, including those related to stroke, brain injury, and neurodegenerative diseases, as well as warning signs that may indicate the need for a referral. Click here for additional information and to register.
AI for Community Health Workers: Practical Tools for Real CHW Work, September 25 | 12:00-1:00 PM
This free training will explore practical, low-cost ways Community Health Workers can use AI to support everyday tasks, including drafting follow-up notes, translating and simplifying materials, preparing for home visits, and gathering referral and resource information. The session will also cover important considerations related to privacy, cultural context, and maintaining the trusted human relationship at the center of CHW work. Click here for additional information and to register.
Molina Healthcare of Illinois invites you to join the upcoming live webinars:
- FQHC, RHC Encounter Clinic Billing, September 24, 1:00 PM Register
- Open Forum Town Hall, September 21, 1:00 PM Register
- Quality Improvements, HEDIS, and More, September 28, 1:00 PM Register
- Dental Provider Training, September 30, 10:00 AM Register
- Provider Orientation October 1, 1:00 PM Register
- Lactation Consultant Billing, October 6, 1:00 PM Register
- Meet Your Dedicated Support Team, October 7, 2:00 PM Register
- Rosters and Credentialing, October 13, 2 PM Register
- Vaccine Billing, October 15, 1:00 PM Register
Looking for additional sessions? Explore the full 2026 schedule of live webinars exclusively for Illinois providers and register for provider updates to receive notices for upcoming trainings.
Aetna Better Health of Illinois
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.
The Summer 2026 newsletter is now available here.
Contact your Provider Relations representative with any questions.
BlueCross BlueShield of Illinois
The September 2026 issue of Blue Review is available here. If you have not already subscribed to receive this publication, you may sign up here. To see this month’s Reimbursement Policy Updates, please click here.
To contact your Provider Network Consultant, visit Provider Network Consultant Assignments for more information.
The Q3 2026 issue of Humana Physician News is available here. If you have not already subscribed to receive publications from Humana, you may sign up here.
Humana’s Medicare Stars Learning team is pleased to offer a series of live, facilitated educational sessions throughout 2026 to help providers stay informed and up to date. Click here to learn more and register.
The “Monthly Provider Check-In” for August 2026 can be found here.
Join Meridian’s live monthly session to stay informed on the latest updates for providers. Click here to register for the next live session on October 13th, 2026.
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.
Website Redesign Launch Postponed
Molina Healthcare of Illinois has postponed the launch of its redesigned public website. Providers should continue using the current website and watch for future communications regarding the updated launch date. Click here for additional information.
Molina is sharing a summary of recent news pertinent to your practice/facility.
Memo topics include Rate/Fee Schedule updates for September 2026, updates to Molina Clinical Policies, and much more! You can find the ‘‘Memo Roundup’’ here.
To register for Illinois provider updates, so you don’t miss any bulletins, Click Here.
Click here to receive information curated exclusively for Molina’s Illinois providers.
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
The September 2026 issue of Network News contains important notifications and updates for healthcare providers.
If you have any QUESTIONS or SUGGESTIONS for TOPICS that you would like to see covered in future issues of the IPHA Billing Digest, please email your suggestions and/or requests to insurancebilling@ipha.com.
Your feedback is valuable and appreciated.
Thank you!
