07/26/2024
What’s Changing: We are changing prior authorization requirements for Blue Cross Medicare Advantage members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association.
Changes, effective Oct. 1, 2024, include addition of lab codes to be reviewed by eviCore healthcare.
Refer to our updated Prior Authorization Lists for Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM available our provider website. You can also review how to submit requests on the Utilization Management page.
Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through Availity® or your preferred vendor.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
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