Authorizations news
10/15/25: Varicose vein authorizations updates
We’re sharing two updates regarding varicose vein procedure authorizations.
October 15, 2025
09/25/2025: Home health care authorizations update
Many home health care services no longer require prior authorization for our in-network providers, effective Sept. 1, 2025.
September 29, 2025
09/17/2025: Reminder: Medicaid members now receive inpatient denial letters
To comply with a recent decision by the Centers of Medicare and Medicaid Services (CMS), Medicaid members whose authorization requests for inpatient services were denied now receive denial letters in the mail.
September 17, 2025
09/10/2025: Withdrawing pending authorizations through GuidingCare is temporarily unavailable
Effective Sept. 10, 2025, providers are temporarily unable to withdraw pending authorizations from GuidingCare directly.
September 10, 2025
Wheelchair authorizations: request only the duration needed
When submitting wheelchair authorization requests for our members, our utilization management team asks that you now request only the duration you anticipate the member will need based on their condition.
August 13, 2025
TurningPoint post-claim appeal updates
We’re sharing a couple of updates on post-claim appeals for medical necessity for cases managed by TurningPoint.
July 7, 2025
Delayed implementation of varicose vein authorizations
Implementation of prior authorization requirements for certain varicose vein procedures is delayed.
June 29, 2025
CGM authorization timeframes by plan type
We’re sharing a quick reminder of our allowed continuous glucose monitor (CGM) authorization timeframes by plan type.
June 29, 2025
Reminder: Our radiation oncology authorization program with EviCore launches Sept 15
Our radiation oncology authorizations program with EviCore, first announced in June, will launch on September 15.
June 29, 2025
Peer-to-peer policy update delayed
Implementation of our recently-announced peer-to-peer policy for inpatient requests is delayed while we gather network feedback.
June 29, 2025
Our authorization request form has a new look
Today you’ll notice our authorization request tool has a new look. To check it out, select Request an Authorization under the Authorizations menu here in prism.
June 29, 2025
TurningPoint launches for cardiac and MSK authorizations
Our new authorization programs with TurningPoint has launched for cardiac and MSK services taking place on and after Sept. 1, 2024.
June 29, 2025