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:
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.
We’re also resuming our usual notification and medical necessity review requirements for the following:
Level of care or service |
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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 |
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