Notice of Changes to Prior Authorization Requirements: February 2019

New prior authorization requirement for providers and/or Material Changes to Contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.

Changes to Prior Authorization Requirements

 

• Medical Policy/Clinical Guidelines Updates – February 2019*

 

• Reimbursement Policy Updates – February 2019*

 

• Clinical criteria updates for specialty pharmacy*

 

• Specialty pharmacy prior authorization list expansion*

 

• Specialty pharmacy medical step therapy drug list expansion*

 

Other Important Updates

 

• Professional billing - Update regarding E/M with modifier 25

 

• Medicare and Medicaid updates