This article is for providers caring for our members
We’re expanding prior authorization requirements for certain services listed in our medical policies to members in our commercial EPO and PPO plans as of June 1, 2022. These requirements will align with those currently in place for our commercial HMO and POS members.
Commercial EPO and PPO plan members who are:
We’ll accept prior authorization requests up to 30 days before June 1, 2022, so that you can have an approved authorization for any services taking place after the effective date.
We previously communicated this change last September and delayed the effective date until this June.
|For these services||Please request authorization|
|Continuous glucose monitors
(Codes: A9277, K0553, S1036)
|Following the same method you use today for HMO/POS members.
|Spine surgeries using InterQual SmartSheets for:
Following the same method you use today for HMO/POS members.
|Other services (refer to list of codes)||Following the same method you use today for HMO/POS members.|
As always, we recommend checking member benefits and eligibility to determine any authorization requirements. You can use Authorization Manager, available on Provider Central, to check any authorization requirements by entering the procedure code.
These resources are available and will be updated on June 1, 2022 to reflect the new authorization requirements:
As always, thank you for the care you provide to our members.