Fax the HFS 1409X Pharmacy Prior Authorization Request Form for Illinois Medicaid fee-for-service patients only; HealthChoice Illinois MCO members use their plan form and fax. FFS drug prior approval phone 800-252-8942 is already listed.
Medical prior approval requests (HFS 1409) — Bureau of Professional and Ancillary Services fax and mail
Official page read
Phone
No phone listed for this route
Fax
217-524-0099
Published hours
Fax Monday through Friday, 8:30 AM – 5:00 PM, except holidays
Product, plan and location
medicaid Illinois
Mailing addressIllinois Department of Healthcare and Family Services
Bureau of Professional and Ancillary Services
Post Office Box 19124
Springfield, Illinois 62794-9124
Mailed HFS 1409 prior approval requests.
Fee-for-service medical prior approval (HFS 1409) for non-optometric services; medications use the pharmacy forms instead. Source is the HFS 1409 instructions revised November 2015 — confirm current routing before relying on it.
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