Notice of Changes to Prior Authorization Requirements - April 2021

New prior authorization requirements for providers may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.

 

Changes to Prior Authorization Requirements

• Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual*
• Updates for specialty pharmacy are available*
• Medical policy and clinical guideline updates*
• Update: Clinical guideline adoption postponed*
• MCG Care Guidelines 25th Edition available*
• Maximizing efficient, high quality COVID-19 screenings*
• New reimbursement policy: Newborn Inpatient Stays for facilities*