Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - October 2020

Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.

• Updated Provider Manual now available*

• Updates for specialty pharmacy are available*
• National Accounts 2021 Pre-certification list*
• Medical policy and clinical guidelines updates*
• Prior authorization update for Commercial Individual Business*
• Reimbursement policy update: Emergency department – Leveling of Evaluation and Management Services (Facility)*
• Reimbursement policy update: Laboratory and venipuncture (Professional)*
• Federal Employee Program^® expands specialty pharmacy prior authorization list*

 

Medicare

• Prior authorization requirements updates
• Medical policies and clinical utilization management guidelines update