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.
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.
Procedure codes impacted by new auth programs
We’re working with TurningPoint Healthcare Solutions LLC (TurningPoint) and EviCore Healthcare (EviCore) to launch new authorizations programs in the coming weeks. Find the procedure types and codes that will be managed through these programs.
Resources and trainings for TurningPoint authorizations
New cardiology and MSK authorization programs are set to launch with TurningPoint for dates of service on Sept. 1, 2024 and after. Starting August 20, your providers will have the opportunity to test the new authorizations submission process.
Finalizing 2024 InterQual criteria transition
Acute Adult and Acute Pediatric will transition to 2024 InterQual criteria effective August 5.
EviCore radiation oncology provider training webinars
Join EviCore to learn about the new radiation oncology authorization program set to launch this September, as well as how to navigate and successfully request authorizations through EviCore.
Portion of 2024 InterQual criteria delayed
As we shared in May, we’re transitioning to 2024 InterQual® criteria on July 15. Part of that transition is delayed.
Provider trainings for TurningPoint authorizations programs
Join our utilization management team and TurningPoint staff to learn about the new cardiology and MSK authorization programs set to launch this September, as well as how to navigate and successfully request authorizations through TurningPoint.
Outpatient peer-to-peer reviews to follow new policy
Effective Oct. 9, 2024, outpatient peer-to-peer reviews (P2P) will only consider the clinical information submitted with the initial authorization request.
Inpatient peer-to-peer policy update goes into effect September 4
Effective Sept. 4, 2024, and in alignment with industry standards, inpatient peer-to-peer reviews (P2P) will only consider the clinical information submitted with the initial authorization request.
New radiation oncology authorizations program to launch this fall
We’re partnering with EviCore on a new authorization program for outpatient radiation oncology procedures. This new program is slated to launch Sept. 15, 2024.
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.