May 2025
We’re changing how we manage self-administered hemophilia products for most Blue Cross, BCN commercial members, starting Sept. 1 (PDF)
Starting Sept. 1, we’ll change how we pay for certain medications for most Blue Cross, BCN commercial members (PDF)
Yesintek to have a site-of-care requirement for most commercial members starting Sept. 1 (PDF)
Ignore questionnaire prompts when requesting organization determinations for pain management procedures for BCN Advantage members (PDF)
New and updated requirements for some medical benefit drugs for Blue Cross commercial URMBT members starting Aug. 20 (PDF)
We’re adding requirements for additional medical oncology drugs for most members starting Aug. 20 (PDF)
Opuviz will require prior authorization for Medicare Advantage members starting Aug. 1 (PDF)
May 26 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
e-referral system out of service for maintenance overnight May 17-18, May 30-June 1 (PDF)
Imaavy IV and Zevaskyn to require prior authorization for most members (PDF)
Register for a May 6 or May 8 Q&A session about the Medical and Pharmacy Drug PA Portal for most commercial members (PDF)
Starting June 1, we’re replacing Stelara with biosimilar drugs for most Medicare Advantage members (PDF)
Additional drugs to require prior authorization for Blue Cross commercial URMBT members starting July 30 (PDF)
Qfitlia to require prior authorization for Medicare Advantage members starting June 1 (PDF)
April 2025
Provider websites unavailable overnight April 25-26 (PDF)
e-referral system out of service for maintenance overnight April 19-20, 25-26 (PDF)
Best practices for submitting prior authorization requests with InterQual Connect questions through the e-referral system (PDF)
April 18 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Update: Selarsdi to require prior authorization for most members (PDF)
Qfitlia SC and some denosumab products to require prior authorization for most commercial members for dates of service on or after April 11 (PDF)
Reminder: Prior authorization won’t be required for pain management procedures for Medicare Advantage members starting May 1 (PDF)
March 2025
Medicare Advantage prior authorization requests submitted through NovoLogix must be submitted through a different application starting July 1 (PDF)
Update: Commercial prior authorization requests submitted through NovoLogix must be submitted through a different application starting April 21 (PDF)
Issue resolved: Providers may experience delays when submitting prior authorization requests to Carelon (PDF)
Changes to prior authorization for select services managed by Blue Cross and BCN starting March 23 (PDF)
Complete the Continuity of Care Guideline in the e-referral system for some Medicare Advantage members starting April 3 (PDF)
Step therapy required for Keytruda and Opdivo for nasopharyngeal cancer for most members starting June 18 (PDF)
Update: Omlyclo and omalizumab-igec require prior authorization for most commercial members for dates of service on or after March 27 (PDF)
Professional reimbursement increased for select procedures performed in ambulatory surgical facilities (PDF)
Encelto to require prior authorization for most members (PDF)
e-referral system out of service for maintenance overnight March 15-16 (PDF)
Denosumab-dssb SC, Osenvelt SC and Stoboclo SC to require prior authorization (PDF)
How we communicate changes to medical policies for medical benefit drugs that require prior authorization for commercial members (PDF)
February 2025
Changes to the management of oncology medical benefit drugs starting June 1 (PDF)
Changes to the Oncology Value Management program starting April 1 (PDF)
Update: Tyenne will be preferred tocilizumab biosimilar product for most commercial members, starting June 1 (PDF)
Alyglo, Amtagvi and Loqtorzi to have requirements for Blue Cross commercial URMBT members starting June 1 (PDF)
Xbryk and Ospomyv to require prior authorization for most commercial members starting Feb. 28 (PDF)
Claims for Medicare Advantage PPO individual members on NASCO system denying as no authorization on file (PDF)
Questionnaire changes in the e-referral system starting Feb. 23 (PDF)
We’ll use updated ABA supplemental policy starting April 22 (PDF)
Update: Step therapy won’t be required for Darzalex Faspro (PDF)
How to obtain CGM products for commercial and Medicare Advantage members (PDF)
Rebyota and Ryoncil will have additional requirements for most commercial members starting March 31 (PDF)
Trazimera to be preferred trastuzumab product for Medicare Advantage members starting May 12 (PDF)
Avtozma to require prior authorization for most commercial members starting Feb. 20 (PDF)
Ahzantive, Enzeevu, Epysqli and Pavblu to require prior authorization for Medicare Advantage members starting May 1 (PDF)
e-referral system out of service for maintenance overnight February 15-16 (PDF)
Step therapy requirements added for Entyvio, Rystiggo, Vabysmo and Vyvgart for Medicare Advantage members starting May 1 (PDF)
Finding which procedure codes require prior authorization by TurningPoint (PDF)
Update: Piasky and Tremfya to have a site-of-care requirement for most commercial members starting June 1 (PDF)
Update: Prior authorization changes for blepharoplasty and percutaneous left atrial appendage closure devices starting Feb. 2 (PDF)
Requesting retroactive authorizations if Carelon displays an incorrect coverage end date for Medicare Plus Blue (PDF)
January 2025
We’ll no longer require prior authorization for pain management procedures for Medicare Advantage members (PDF)
Some continuous glucose monitoring products available through participating network pharmacies for commercial members (PDF)
Evenity to have additional step therapy requirements for Medicare Advantage members starting May 1 (PDF)
New Acute inpatient hospital assessment form for commercial and Medicare Advantage members (PDF)
We’re changing how we manage Stelara and Stelara biosimilar therapies for most commercial members, starting April 1 and May 1 (PDF)
Continue to answer InterQual Connect questions in the e-referral system while we investigate technical issues (PDF)
Updated: Simlandi preferred adalimumab product for Blue Cross, BCN commercial members (PDF)
New Blue Elect Plus HRA POS (PDF)
Additional drugs to have requirements for Blue Cross commercial URMBT members starting April 16 (PDF)
EviCore category assignments and practitioner performance summaries for PTs and OTs will be available Feb. 3 (PDF)
Submit reconsideration requests for commercial members through the TurningPoint provider portal (PDF)
Jan. 20 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
How to enter subscriber/enrollee IDs when submitting electronic prior authorization requests for pharmacy benefit drugs (PDF)
e-referral system out of service for maintenance overnight January 18-19 (PDF)
Alhemo to require prior authorization for most commercial members starting Jan. 16 (PDF)
Finding which procedure codes require authorization by Carelon or EviCore (PDF)
Commercial prior authorization requests submitted through NovoLogix must be submitted through a different application starting April 1 (PDF)
Ryoncil to require prior authorization for most members (PDF)
December 2024
Cosentyx IV to have an additional step therapy requirement for most commercial members starting Feb. 12 (PDF)
Generic pemetrexed to require prior authorization for most members starting Jan. 1 (PDF)
Steqeyma to require prior authorization for most members (PDF)
Online behavioral health care navigation solution to end March 2025 (PDF)
Enzyme replacement therapy drugs to have a quantity limit requirement for most commercial members (PDF)
Questionnaire updates in the e-referral system effective Dec. 22 (PDF)
December – January holiday closure: How to submit authorization requests for inpatient admissions (PDF)
e-referral system out of service for maintenance overnight December 21-22 (PDF)
Starting Feb. 1, 2025, Cimzia will change to nonpreferred on our prescription drug plans (PDF)
Elrexfio, Eylea HD and Vyvgart Hytrulo to have requirements for Blue Cross commercial URMBT members starting March 13 (PDF)
Beqvez and Kebilidi will have additional requirements for most commercial members starting Jan. 27 (PDF)
Share Your Feedback on the New Provider Prior Authorizations Website Before Launch - Sneak Peek Available Until Dec. 16 (PDF)
Until Dec. 22, fax requests for prospective inpatient admissions with procedure code *99222 (PDF)
Update: Providers can upload medical records through Availity Essentials for additional types of requests, starting Dec. 16 (PDF)
Yesintek to require prior authorization for most members (PDF)
Omvoh IV and SC to have an additional step therapy requirement for most commercial members starting Jan. 17 (PDF)
More information about the Oncology Value Management program through OncoHealth (PDF)
November 2024
Questionnaires removed from the e-referral system on Nov. 24 (PDF)
Bkemv, Niktimvo and Pyzchiva will require prior authorization for Medicare Advantage members starting Feb. 3 (PDF)
Nov. 28-29 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Kebilidi to require prior authorization for most members (PDF)
Aucatzyl IV to require prior authorization for most members starting Nov. 21 (PDF)
Update: Changes to preferred drug designations under the medical benefit for most members, starting Jan. 1 (PDF)
e-referral system out of service for maintenance overnight November 16-17 (PDF)
Guidance and instructions for completing NOMNC and DENC forms for post-acute care stays for Medicare Advantage members (PDF)
October 2024
Register for a Nov. 22 session about changes to post-acute care services for Medicare Advantage members (PDF)
Step therapy requirements added for Soliris, Ultomiris and Simponi Aria for Medicare Advantage members starting Feb. 3 (PDF)
Nov. 5 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Hympavzi and Imuldosa to have a prior authorization requirement for most members (PDF)
BAHA (Bone-anchored hearing aid) questionnaire removed from the e-referral system (PDF)
We changed how we manage immunoglobulin therapies for most commercial members starting Oct. 1 (PDF)
Prior authorization approvals now valid for 180 days for PTs and OTs in Category A (PDF)
e-referral system out of service for maintenance overnight October 19-20 (PDF)
Tremfya IV will require prior authorization for Medicare Advantage members starting Dec. 2 (PDF)
Otulfi to have a prior authorization requirement for most members (PDF)
Register now for Oct. 10 webinar on prior authorization programs with Carelon (PDF)
Select a recommended procedure when answering InterQual Connect questions in the e-referral system (PDF)
September 2024
Updated forms now available for submitting prior authorization requests for post-acute care services (PDF)
Tezspire to have a site-of-care requirement for most commercial members starting Jan. 1 (PDF)
Changes to the Breast Elastography Trigger questionnaire in the e-referral system (PDF)
Facilities can now enter post-acute care prior authorization requests for Medicare Advantage members in e-referral (PDF)
2025 coverage change for GLP-1 drugs to treat obesity (PDF)
Preferred product for Hemgenix for most commercial members starting Nov. 11 (PDF)
Beqvez to require prior authorization for Federal Employee Program non-Medicare members starting Jan. 1 (PDF)
Update: Changes to preferred drug designations under the medical benefit for most members, starting Jan. 1 (PDF)
Medical benefit oncology drugs that will require prior authorization through OncoHealth starting Jan. 1 (PDF)
Elrexfio, Lunsumio, Talvey and Tecvayli will have additional requirements for most commercial members (PDF)
Ocrevus Zunovo SC to have requirements for most commercial members starting Oct. 3 (PDF)
Update: Tremfya IV to require prior authorization for most commercial members starting Sept. 26 (PDF)
e-referral system out of service for maintenance overnight September 21-22 (PDF)
Jubbonti and Wezlana to require prior authorization for Medicare Advantage members starting Nov. 3 (PDF)
Rituximab preferred agents to change for Medicare Advantage members starting Jan. 1 (PDF)
August 2024
Additional musculoskeletal spinal procedures to require prior authorization for Blue Cross commercial members starting Nov. 27 (PDF)
Update: Learn more about changes related to post-acute care services for Medicare Advantage members starting Oct. 1 (PDF)
Pavblu to require prior authorization for most commercial members starting Sept. 5 (PDF)
Sept. 2 holiday closure: How to submit authorization requests for inpatient admissions (PDF)
Update: Prior authorization changes for blepharoplasty, enteral nutrition, percutaneous left atrial appendage and varicose vein treatment starting Sept. 8 (PDF)
Niktimvo IV to require prior authorization for most commercial members starting Sept. 5 (PDF)
Zynyz and Talvey to require prior authorization for URMBT members with Blue Cross non-Medicare plans (PDF)
Enzeevu to require prior authorization for most commercial members starting Aug. 29 (PDF)
PiaSky and Tecelra will require prior authorization for Medicare Advantage members starting Oct. 1 (PDF)
e-referral system out of service for maintenance overnight August 17-18 (PDF)
Physician appointment access survey in process (PDF)
Tecelra to require prior authorization for most commercial members starting Aug. 15 (PDF)
July 2024
Preferred immune globulin products for Medicare Advantage members to change starting Nov. 1 (PDF)
Rytelo to require prior authorization for most commercial members starting Aug. 8 (PDF)
Update: Changes coming for select weight loss drugs for some commercial members (PDF)
Blue Cross Behavioral Health no longer requires autism diagnostic re-evaluations (PDF)
Guidelines for billing Avastin for Blue Cross and BCN commercial members (PDF)
Epysqli to require prior authorization for most commercial members starting Aug. 8 (PDF)
Changes to the BCN referral and authorization requirements for Michigan providers document (PDF)
Tyenne, Tofidence and Zinplava to have a site-of-care requirement for most commercial members starting Nov. 1 (PDF)
Rytelo will require prior authorization for Medicare Advantage members starting Aug. 1 (PDF)
Updated TurningPoint medical policies for musculoskeletal and pain management procedures (PDF)
Release schedule for eviCore category assignments and practitioner performance summaries for PTs and OTs (PDF)
Kisunla and Ohtuvayre will require prior authorization for Medicare Advantage members starting July 15 (PDF)
Kisunla to require prior authorization for most commercial members starting July 18 (PDF)
e-referral system unavailable on two weekends in July (PDF)
Ahzantive, Nypozi and Pyzchiva to require prior authorization for most commercial members starting July 18 (PDF)
Home health care services won’t require prior authorization for Medicare Advantage members starting Oct. 1 (PDF)
We’re changing how we manage immunoglobulin therapies for most commercial members starting Oct. 1 (PDF)
