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Auth requirements and credentialing procedures continue to be relaxed
March 2, 2022

This article is for all providers caring for our members

We continue to waive authorization requirements and expedite credentialing applications through the dates listed below. This is in response to the Division of Insurance Bulletin 2022-03 – Relaxation of Prior Authorization and Credentialing Procedures in Response to Health Facility Staffing and Capacity Constraints (issued February 23, 2022).

Authorization requirements continue to be 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 May 16, 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 May 16, 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
May 16, 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

Concurrent and retrospective reviews

Beginning April 18, 2022, we will resume concurrent and retrospective reviews of the first five days of any post-acute facility stay following a transfer from an acute or mental health hospital. Until then, we are conducting concurrent review at day six.

Postponed procedures

If you previously received an approved authorization for a service that was postponed, please be sure to notify us if you have a new date. This will help with claim processing.

Expediting credentialing

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