Provider Alerts Archive: 2025

Update: Medicare Advantage prior authorization requests submitted through NovoLogix must be submitted through a different application starting Aug. 1

Changes to prior authorization requirements for additional services managed by BCN starting June 29

Submit prior authorization requests for FEP members through the e-referral system starting Oct. 6

July 4 holiday closure: How to submit authorization requests for inpatient admissions

Reminder: Submit prior authorization requests for non-emergency air ambulance flights to Alacura before takeoff

e-referral system out of service for maintenance overnight June 21-22

Submit clinical documentation for most drugs through the Medical and Pharmacy Drug PA Portal for commercial members

June 19 holiday closure: How to submit authorization requests for inpatient admissions

Update to InterQual Connect question in the e-referral system for varicose vein treatment

Register now for June 17 webinar on prior authorization best practices with Carelon

Inpatient admissions for musculoskeletal procedures managed by TurningPoint

Starjemza to require prior authorization for most commercial members starting June 12

Gamifant to require prior authorization for most members starting Sept. 3

Answers to questions about changes to requirements for pain management procedures for our Medicare Advantage members

Changes to prior authorization for select services managed by BCN starting June 2 and June 29

We’re changing how we manage self-administered hemophilia products for most Blue Cross, BCN commercial members, starting Sept. 1

Starting Sept. 1, we’ll change how we pay for certain medications for most Blue Cross, BCN commercial members

Yesintek to have a site-of-care requirement for most commercial members starting Sept. 1

Ignore questionnaire prompts when requesting organization determinations for pain management procedures for BCN Advantage members

New and updated requirements for some medical benefit drugs for Blue Cross commercial URMBT members starting Aug. 20

We’re adding requirements for additional medical oncology drugs for most members starting Aug. 20

Opuviz will require prior authorization for Medicare Advantage members starting Aug. 1

May 26 holiday closure: How to submit authorization requests for inpatient admissions

e-referral system out of service for maintenance overnight May 17-18, May 30-June 1

Imaavy IV and Zevaskyn to require prior authorization for most members

Register for a May 6 or May 8 Q&A session about the Medical and Pharmacy Drug PA Portal for most commercial members

Starting June 1, we’re replacing Stelara with biosimilar drugs for most Medicare Advantage members

Additional drugs to require prior authorization for Blue Cross commercial URMBT members starting July 30

Qfitlia to require prior authorization for Medicare Advantage members starting June 1

Provider websites unavailable overnight April 25-26

e-referral system out of service for maintenance overnight April 19-20, 25-26

Best practices for submitting prior authorization requests with InterQual Connect questions through the e-referral system

April 18 holiday closure: How to submit authorization requests for inpatient admissions

Update: Selarsdi to require prior authorization for most members

Qfitlia SC and some denosumab products to require prior authorization for most commercial members for dates of service on or after April 11

Reminder: Prior authorization won’t be required for pain management procedures for Medicare Advantage members starting May 1

Medicare Advantage prior authorization requests submitted through NovoLogix must be submitted through a different application starting July 1

Update: Commercial prior authorization requests submitted through NovoLogix must be submitted through a different application starting April 21

Issue resolved: Providers may experience delays when submitting prior authorization requests to Carelon

Changes to prior authorization for select services managed by Blue Cross and BCN starting March 23

Complete the Continuity of Care Guideline in the e-referral system for some Medicare Advantage members starting April 3

Step therapy required for Keytruda and Opdivo for nasopharyngeal cancer for most members starting June 18

Update: Omlyclo and omalizumab-igec require prior authorization for most commercial members for dates of service on or after March 27

Professional reimbursement increased for select procedures performed in ambulatory surgical facilities

Encelto to require prior authorization for most members

e-referral system out of service for maintenance overnight March 15-16

Denosumab-dssb SC, Osenvelt SC and Stoboclo SC to require prior authorization

How we communicate changes to medical policies for medical benefit drugs that require prior authorization for commercial members

Changes to the management of oncology medical benefit drugs starting June 1

Changes to the Oncology Value Management program starting April 1

Update: Tyenne will be preferred tocilizumab biosimilar product for most commercial members, starting June 1

Alyglo, Amtagvi and Loqtorzi to have requirements for Blue Cross commercial URMBT members starting June 1

Xbryk and Ospomyv to require prior authorization for most commercial members starting Feb. 28

Claims for Medicare Advantage PPO individual members on NASCO system denying as no authorization on file

Questionnaire changes in the e-referral system starting Feb. 23

We’ll use updated ABA supplemental policy starting April 22

Update: Step therapy won’t be required for Darzalex Faspro

How to obtain CGM products for commercial and Medicare Advantage members

Rebyota and Ryoncil will have additional requirements for most commercial members starting March 31

Trazimera to be preferred trastuzumab product for Medicare Advantage members starting May 12

Avtozma to require prior authorization for most commercial members starting Feb. 20

Ahzantive, Enzeevu, Epysqli and Pavblu to require prior authorization for Medicare Advantage members starting May 1

e-referral system out of service for maintenance overnight February 15-16

Step therapy requirements added for Entyvio, Rystiggo, Vabysmo and Vyvgart and for Medicare Advantage members starting May 1

Finding which procedure codes require prior authorization by TurningPoint

Update: Piasky and Tremfya to have a site-of-care requirement for most commercial members starting June 1

Update: Prior authorization changes for blepharoplasty and percutaneous left atrial appendage closure devices starting Feb. 2

Requesting retroactive authorizations if Carelon displays an incorrect coverage end date for Medicare Plus Blue

We’ll no longer require prior authorization for pain management procedures for Medicare Advantage members

Some continuous glucose monitoring products available through participating network pharmacies for commercial members

Evenity to have additional step therapy requirements for Medicare Advantage members starting May 1

New Acute inpatient hospital assessment form for commercial and Medicare Advantage members

We’re changing how we manage Stelara and Stelara biosimilar therapies for most commercial members, starting April 1 and May 1

Continue to answer InterQual Connect questions in the e-referral system while we investigate technical issues

Updated: Simlandi preferred adalimumab product for Blue Cross, BCN commercial members

New Blue Elect Plus HRA POS

Additional drugs to have requirements for Blue Cross commercial URMBT members starting April 16

EviCore category assignments and practitioner performance summaries for PTs and OTs will be available Feb. 3

Submit reconsideration requests for commercial members through the TurningPoint provider portal

Jan. 20 holiday closure: How to submit authorization requests for inpatient admissions

How to enter subscriber/enrollee IDs when submitting electronic prior authorization requests for pharmacy benefit drugs

e-referral system out of service for maintenance overnight January 18-19

Alhemo to require prior authorization for most commercial members starting Jan. 16

Finding which procedure codes require authorization by Carelon or EviCore

Commercial prior authorization requests submitted through NovoLogix must be submitted through a different application starting April 1

Ryoncil to require prior authorization for most members