Retrospective authorizations limited effective Nov. 1
Effective Nov. 1, 2026, prior authorization must be obtained before services are rendered for all services that require authorization.
Notice of Admission requirement postponed
In April, we announced that we’d require Notice of Admission for medical inpatient hospital admissions effective Sept. 1, 2026. To allow additional time to develop a manual submission option in our new Provider Portal, we’re postponing this requirement.
Postponed removal of Medicare inpatient acute authorization requirements
In June, we announced that we’d remove authorization requirements for Medicare inpatient acute medical admissions effective Sept. 1, 2026. Following additional review of regulatory considerations, we’re postponing the change.
Auth Inquiry is back up and running
The Auth Inquiry tool in prism is now fixed after experiencing an outage.
Submit transplant & NICU authorizations via our provider portal, effective Sept. 1
Starting Sept. 1, 2026, submit authorization requests for the following through our Provider Portal: NICU & sick newborn, solid organ transplant and bone marrow / stem cell transplant.
Authorizations update for Medicare inpatient acute
We're evaluating the possibility of removing authorization requirements for Medicare inpatient acute medical admissions. This change has been postponed from it's original Sept. 1, 2026, effective date.
Update to inpatient readmission review and appeal processes
In alignment with industry standards, inpatient readmissions for Medicare plans are now determined after the claim is submitted, rather than at the time of authorization review.
We'll use 2026 InterQual criteria starting July 13
Beginning July 13, 2026, we'll use 2026 InterQual criteria to make medical necessity determinations on prior authorization requests.
Reminder: 7 days is the new standard authorization turnaround time
As a reminder, the Centers for Medicare and Medicaid Services (CMS) now require health plans to decision standard authorization requests within seven (7) days of receipt. This change went into effect Jan. 1, 2026.
P2P update for Medicare inpatient acute authorizations
We’ve updated how we handle peer-to-peer conversations (P2P) for inpatient acute authorization denials for our Medicare, D-SNP and HIDE-SNP plans.
2026 scheduled maintenance dates for TurningPoint's authorizations portal
TurningPoint’s authorizations portal is intermittently offline for scheduled maintenance one evening per month, from 7 p.m. on a Saturday to 12 a.m. the following Sunday (Eastern Time).
We’re updating our processes for inpatient acute authorizations
We’re working to align our utilization management (UM) processes for inpatient acute authorizations for Medicare and Medicaid, and to ensure we’re in compliance with both CMS regulations and state recommendations for HIDE-SNP implementation.