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Reminder: Authorization required for musculoskeletal services
April 3, 2023

This article is for physicians and clinicians who provide musculoskeletal services

As a reminder, as of April 1, we require prior authorization for pre-scheduled inpatient and outpatient musculoskeletal services, including spine, joint, and pain management procedures. This update applies to our commercial (HMO, PPO) and Medicare Advantage members, and does not impact Federal Employee Program (FEP) members. We notified you of this change in our November 28 News Alert.

What do I need to do?

You will need to use Authorization Manager to submit initial authorization requests for musculoskeletal services. Authorization Manager, available 24/7, is the quickest way to review authorization requirements, request authorizations, check existing case status, and view or print the decision letter. For commercial members, your requests must meet InterQual® criteria and our medical policy guidelines. Requests for Medicare Advantage members must adhere to CMS guidelines.

To ensure your request is processed accurately and quickly:

  • Enter the facility’s NPI or provider ID for where services are being performed.
  • Enter the appropriate surgeon’s NPI or provider ID as the servicing provider, not the billing group

Resources

MPC_030822-2N–4-ART