03/11/2025
Illinois Medicaid Behavioral Health update (effective January 1, 2026).
Molina Healthcare of Illinois is changing inpatient Behavioral Health notification and review timelines to comply with the Healthcare Protection Act.
• Notify Molina within 48 hours of inpatient admission to receive a reference number.
• If notification is on time, concurrent review starts 72 hours after admission; if late, it starts day 1.
• To extend past 72 hours, submit a continued stay request within 12 hours after the initial 72-hour window with clinicals from admission through 72 hours + the reference number.
• Daily rounding required by a psychiatrist (MD/DO) or certified mental health NP in inpatient BH settings.
Tip: Make sure your admissions + UM teams have this saved, and verify Availity Essentials access for authorizations, eligibility, and claims.
Save & share with your team. Need help tightening your workflow? BCN can streamline your intake-to-UM steps.