Authorizations news
Reminder of varicose vein authorizations implementation
As we shared in October, we'll require prior authorization following InterQual® criteria for certain varicose vein procedures effective Jan. 1, 2025, for commercial and Medicaid plans and in 2026 for Medicare plans.
New authorization requirement for non-urgent inpatient hospital transfers
When a member is receiving non-urgent inpatient care, we’ll soon require prior authorization before their care can be transferred to a different facility. This change will go into effect Mar. 10, 2025, and won’t impact urgent / emergent hospital transfers.
New authorization requirement for renal denervation
Effective Apr. 6, 2025, we’ll require prior authorization for the following procedures for Medicare cases: 0338T and 0339T.
Reminder callbacks not possible for inpatient P2P cases
We’re sharing a reminder that call backs to our medical director team aren’t available for missed peer-to-peer (P2P) calls for inpatient cases.
New prior authorization requirement for cardiac procedures
Effective Apr. 21, 2025, we’ll require prior authorization for the following cardiac procedures, for all lines of business: 92924 and C1605.
Authorization requests for 73700 and 73200 now auto approve
Authorization requests for diagnostic imaging procedures 73700 and 73200 now auto approve.
2025 InterQual transition coming June 2
Beginning June 2, 2025, we’ll use 2025 InterQual® criteria to make medical necessity determinations on prior authorization requests.
Authorization appeal update effective June 2
Effective June 2, 2025, we won’t review post-claim appeals for medical necessity when a denied authorization is on file for the following authorization types, for all lines of business: outpatient, home health, DME, elective inpatient, behavioral health.
Reminder EviCore radiation oncology authorizations and resources
As a reminder, our new radiation oncology authorizations program with EviCore launched on Sept. 15, 2024. To support you in getting your patients, our members, the care they need when they need it, EviCore offers a variety of provider resources and trainings.
New DME auth requirement for Q0508
Effective July 15, 2025, we’ll require prior authorization for HCPCS code Q0508 – used for miscellaneous supplies or accessories used with an implanted ventricular assist device (VAD) –when exceeding our standard DME thresholds.
TurningPoint portal downtime on May 24
TurningPoint's provider portal will be temporarily offline for scheduled maintenance between 7-9 p.m. ET on May 24.
Delayed implementation of varicose vein authorizations
Implementation of prior authorization requirements for certain varicose vein procedures is delayed.