Authorizations news
Finalizing 2024 InterQual criteria transition
Acute Adult and Acute Pediatric will transition to 2024 InterQual criteria effective August 5.
June 29, 2025
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.
June 29, 2025
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.
June 29, 2025
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.
June 29, 2025
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.
June 29, 2025
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.
June 29, 2025
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.
June 29, 2025
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.
June 25, 2025
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.
June 25, 2025
Authorization requests for 73700 and 73200 now auto approve
Authorization requests for diagnostic imaging procedures 73700 and 73200 now auto approve.
June 25, 2025
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.
June 25, 2025
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.
June 25, 2025