IlliniCare Health (IL Medicaid)

MedicaidIL

ABA billing requirements · Source: IlliniCare Health — Provider Resources (Behavioral Health)

High confidence

Verified 2026-03-16

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

BH carve-out managerCarelon

State licensure requiredBCBA state licensure required via IL Department of Financial and Professional Regulation

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Caregiver training plan

Progress summary cadenceEvery 6 months

Policy Notes

IlliniCare Health (Centene subsidiary) is an Illinois Medicaid MCO. ABA prior auth required. Behavioral health managed through Carelon. BCBA must be enrolled with IlliniCare and Illinois Medicaid.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for IlliniCare Health (IL Medicaid).

Official policy source:IlliniCare Health — Provider Resources (Behavioral Health)

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Data last verified: 2026-03-16 · Confidence: High · See our methodology

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