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Authorization requirements previously relaxed to resume May 17
May 6, 2022

This article is for all providers caring for our members

In March, we told you that prior authorization requirements for certain services were relaxed through May 16, 2022 as required by the Division of Insurance (Bulletin 2022-03).

Effective for dates of service on and after May 17, 2022, we will resume our standard notification, prior authorization, and authorization requirements for coverage 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

This applies to members belonging to all of our health plans, including commercial HMO, PPO, and Indemnity.
Note: We did not waive authorization requirements for Medicare Advantage or Federal Employee Program (FEP) to begin with, so standard processes continue to apply.

Notification requirements resume

We’re also resuming our usual notification and medical necessity review requirements for the following:

Level of care or service
Behavioral health – inpatient
Behavioral health – acute residential treatment, partial hospitalization, and intensive outpatient program
Pre-service inpatient
Skilled nursing facility, rehabilitation, and long-term acute care hospitals
Benefit limits still apply
Home health care
Benefit limits still apply