Changes to prior authorization requirements and medical necessity review for these services are part of our continued dedication to supporting providers in our shared commitment to high quality health care for our participants. Our goal is to enhance the provider experience by making it easier for providers to navigate the prior authorization process, helping ensure timely member access to necessary services.  

 
The following changes to prior authorization requirements took effect 7/1/2024 to align with CMS 3rd quarter updates.
 
Prior authorization is required for the codes listed in Table 2, below:
  
The following changes to prior authorization requirements took effect on 8/1/2024:
  

As a reminder, to verify whether a service requires prior authorization, use the Prior Authorization Lookup Tool on the provider website. Remember, you can save time by submitting your medical authorizations electronically via NaviNet. 

 
Questions? Please contact your Provider Account Executive or call Provider Services at  

1-833-644-6001. 
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