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October 2026
Back to Health: Your October Third Party Billing Digest
As fall settles in, it’s a great time to take a fresh look at the latest healthcare billing updates and resources. This month’s digest brings together important payer updates, billing guidance, compliance reminders, and training opportunities to support your organization’s third-party billing efforts. From seasonal reminders to policy changes and upcoming learning opportunities, we’ve gathered helpful information to keep you informed and set your team up for success this October.
New Digital Interfaces for Prior Authorization Requests
Blue Cross and Blue Shield of Illinois (BCBSIL) will introduce new digital interfaces effective January 1, 2027, to simplify prior authorization requests and improve access to patient information. Available for Medicare Advantage, Medicaid, and select commercial members, these tools will allow providers to check authorization requirements, identify needed documentation, update requests, and track their status in real time. Providers will also be able to access certain patient information through their electronic health record systems. Additional training and support resources will be shared in the coming months. For additional details, please review the provider notice by clicking here.
Illinois Department of Healthcare and Family Services (HFS)
Federal Rule on Gender-Affirming Care for Young People
Illinois Department of Healthcare and Family Services (HFS) issued a provider notice regarding a new federal rule effective October 13, 2026, affecting federal Medicaid funding for certain gender-affirming care services for young people. Illinois will use state-only funds to maintain coverage and continuity of care for affected services through the end of State Fiscal Year 2027. Providers may continue delivering and billing for these services through Medicaid Fee-for-Service and HealthChoice Illinois Managed Care Organizations (MCOs) and should follow existing billing instructions. For additional information, please click here.
Original Clinical Documentation Required with Authorization Requests
Molina Healthcare of Illinois reminds providers that all authorization requests must include original clinical documentation and supporting records. Edited, copied, pasted, or summarized documentation will not be accepted and may result in an adverse benefit determination. Authorization requests must be submitted digitally through Availity® Essentials, with exceptions for pharmacy requests and delegated utilization management vendors, which follow separate submission procedures. For complete information, please click here to review the provider notice.
National Dental Hygiene Month: EPSDT Oral Health Reminders
October is National Dental Hygiene Month, a great time to highlight early oral health care for children enrolled in Medicaid. Providers should conduct oral health risk assessments at six and nine months, refer children to a dental home within six months of their first tooth erupting or by age one, and incorporate oral health guidance and fluoride varnish into well-child visits when appropriate. Proper documentation and coding are also important. For additional information on EPSDT requirements and billing guidance, please click here.
Reminder: Procedure Code and Fee Schedule Updates
Blue Cross and Blue Shield of Illinois (BCBSIL) will implement updates to Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes effective January 1, 2027. These updates include new, deleted, and revised procedure codes. Providers should review the changes and update their billing systems accordingly, as deleted codes will not be accepted for payment for dates of service on or after January 1, 2027. For additional information on the affected codes and how to request updated fee schedules, please click here.
Balance Billing Is Not Allowed
Molina Healthcare of Illinois reminds providers that members cannot be balance billed for covered services beyond applicable copayments, coinsurance, or deductibles. This includes emergency and medically necessary covered services, as well as prohibiting charges to members for covered services denied or rejected by the health plan for valid reasons. Providers are responsible for verifying member eligibility and obtaining prior authorization when required. For additional information and examples of prohibited balance billing practices, please click here.
Protect Patients During Respiratory Virus Season
Molina Healthcare of Illinois is reminding providers to follow Illinois Department of Public Health (IDPH) guidance for 2026 respiratory virus immunizations, including influenza, respiratory syncytial virus (RSV), and COVID-19 vaccines. Providers are encouraged to check immunization status at every visit, offer recommended vaccines, identify eligible patients, and use reminder and recall strategies to reach those who remain unvaccinated. For additional information on vaccine recommendations and provider guidance, please click here.
Website Redesign and Updated Provider Resources
Molina Healthcare of Illinois has redesigned its website, updating navigation and page names for provider resources. Providers are encouraged to update their bookmarks to access Illinois-specific provider memos, billing guidance, fee schedules, prior authorization resources, forms, and upcoming webinars. For additional information and links to updated provider resources, please click here.
HR1 Medicaid Changes: Provider Resources for Redetermination and Coverage Renewal
Meridian has compiled resources to help providers prepare for upcoming federal Medicaid changes under HR1, beginning in 2027. Changes include new work requirements for certain adults enrolled through the Affordable Care Act (ACA) Medicaid expansion and more frequent, six-month eligibility renewals. Providers can access guidance on identifying potentially affected members through Meridian’s secure provider portal, reviewing redetermination dates, and helping members understand steps to maintain coverage. For additional information and provider resources, please click here.
Blue Cross and Blue Shield of Illinois (BCBSIL) – Medicaid Post Payment Review Webinars
Blue Cross and Blue Shield of Illinois (BCBSIL) is offering a limited webinar series for Medicaid-contracted providers to explain its new post payment review process, which began October 2, 2026. The reviews will help identify billing inconsistencies, verify coding accuracy, and ensure claims align with reimbursement policies. Sessions will cover the review process, potential payment adjustments, and next steps for providers.
Upcoming Webinar Sessions:
- October 26, 2026 | 2:00–3:00 PM
- October 29, 2026 | 2:00–3:00 PM
- October 30, 2026 | 10:00–11:00 PM
Providers are encouraged to attend one of the sessions to learn more about the review process and what to expect. Click here to register for a session and review the full provider notice.
Join the Illinois Public Health Association's Help. Guide. Thrive. Lunch & Learn Series for an upcoming educational opportunity designed to support healthcare professionals and strengthen client-centered care:
A Focus on Fatherhood: The Men’s Health Impact, October 27, 11:00 AM–12:00 PM
Explore how fatherhood and father engagement influence men’s health and the well-being of mothers and children. Presented by the Illinois Department of Public Health’s Men’s Health Section Chief, this session will highlight men’s health trends, research findings, and opportunities to engage fathers in public health programming and healthcare services. For additional information and to register, please click here.
Clinical Documentation Improvement Webinar Series – October and November 2026
Meridian is offering a series of no-cost continuing education webinars through its parent company, Centene, to help providers, coders, billers, and administrative staff strengthen clinical documentation and coding accuracy. Topics include cardiovascular coding, obesity documentation, risk adjustment, acute conditions, and 2027 ICD-10 and model updates. Continuing education credits may be available for select sessions. For additional information, course dates, and registration links, please click here.
Molina Healthcare of Illinois invites you to join the upcoming live webinars:
- FQHC, RHC Encounter Clinic Billing, October 22, 1:00 PM Register
- Quality Improvements, HEDIS, and More, October 26, 1:00 PM Register
- Dental Provider Training, October 29, 10:00 AM Register
- CMHC and SUPR Town Hall, October 29, 1:00 PM Register
- Doula Billing, November 3, 1:00 PM Register
- D-SNP Reimbursement, November 2, 1:00 PM Register
- CCBHC Program in Medicaid, November 4, 2:00 PM Register
- Provider Orientation, November 5, 2:00 PM, Register
- Avoiding Common Denials, November 9, 1:00 PM Register
- Marketplace Plan, November 13, 2:00 PM Register
- Dental Provider Training, November 19, 2:00 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 October 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 September 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 November 10, 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.
Molina is sharing a summary of recent news pertinent to your practice/facility.
Memo topics include: Rate/Fee Schedule updates for October 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 October 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!
