Medicare AdvantageSeptember 30, 2020
Prior authorization requirements for the below codes (January 1, 2021)
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
On January 1, 2021, Empire BlueCross BlueShield prior authorization (PA) requirements changed for codes below. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.
See attached for a list of prior authorization requirements that will be added.
Not all prior authorization requirements are listed here. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at www.availity.com at https://www.empireblue.com/medicareprovider > Login. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member’s ID card.
ATTACHMENTS: PA_Jan 2021.pdf (pdf - 0.5mb)
PUBLICATIONS: October 2020 Empire Provider News
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