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October 25, 2022

Beginning Jan. 1, 2023, we’re adding a pre-authorization (PA) requirement to coverage of specific cardiac procedures for members on all fully insured group, Individual and Medicare Advantage plans. This change will help ensure providers follow the standard of care for the specific service and avoid unnecessary and potentially more invasive procedures and their associated costs.

In addition, the PA requirement supports our commitment to improving the clinical appropriateness of cardiac services delivered to our members. The burden of PA lies with the provider and, if the provider is in network, they cannot balance bill members.

We anticipate this change will be transparent to the member. We notified providers of this change in our Oct. 1 Provider News email and will communicate the change to employers in the November edition of Employer News.

Questions? Contact your account representative.