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Authorization requirements and credentialing procedures relaxed
November 24, 2021

This article is for all providers caring for our members

To address health facility staffing and capacity constraints, effective as of November 18, 2021, we are waiving authorization requirements and expediting credentialing applications through February 15, 2022. This is in response to the Division of Insurance Bulletin 2021-15 – Relaxation of Prior Authorization and Credentialing Procedures in Response to Health Facility Staffing and Capacity Constraints.

Authorization requirements are waived for Commercial HMO and PPO, and Indemnity members only for the following services:

  • All inpatient treatment, both COVID-19 and non-COVID-19-related, at acute care and post-acute care facilities  
  • Mental health admissions
  • Scheduled surgeries

Important note: Services for Medicare Advantage and Federal Employee Program (FEP) members will continue to follow standard prior authorization processes.

Continue to notify of admissions

Through dates of service up to and including February 15, 2022, inpatient acute care hospitals and mental health hospitals must continue to notify us of inpatient admissions. Timely notification serves to facilitate care coordination, mobilize services to support transition of care, and ensure prompt claims processing. While this notification-only requirement is in place, we will not perform medical necessity reviews.


Notification only required Does not require submission of clinical documentation for initial admission or concurrent review
Medical necessity review required Requires that the requesting provider submit clinical documentation in support of the request

Notification requirements by service and product

These requirements are in effect for dates of service through February 15, 2022.

Level of care or service Requirement for Commercial HMO and PPO; Indemnity
Behavioral health – inpatient Notification only
Behavioral health – acute residential treatment (partial hospitalization & intensive outpatient program) Notification only
Pre-service inpatient
(For dates of service on or before February 15, 2022)
Notification only
Skilled nursing facility, rehabilitation, and long-term acute care hospitals
Benefit limits still apply
Notification only 
Home health care
Benefit limits still apply
Medical necessity review

Delaying authorization requirements for commercial EPO, PPO (not for Medicare Advantage)

We previously notified you that we would require prior authorization for services listed in our medical policies for EPO, PPO, and Medicare Advantage members, including:

Given the guidance from the DOI, we will only require prior authorization for Medicare Advantage members starting on January 1, 2022.

Expediting credentialing

We are also expediting credentialing for providers to meet the recent DOI requirement. 

What does this mean if you are going through credentialing now or if it’s in process?

You do not need to do anything. We will expedite credentialing for all new providers and for all credentialing applications in process. We will confirm your approval and effective date through our standard correspondence.