We are currently experiencing higher than normal volumes for faxed prior authorization requests. As we work to resolve the issues, we will only require prior authorization for specified services and for a designated period of time. We intend to reinstate all normal prior authorization requirements after these timeframes expire unless we communicate otherwise.

For services listed below, other than Behavioral Health, this change in scope of prior authorization requirements is effective from 2/22/2024 through close of business, 6pm CST, 3/3/2024.

Behavioral Health prior authorization requirements below are effective from 2/22/2024 through close of business, 6pm CST, 2/29/2024.

Prior authorization requirements for DSNP members are not changing.

Services requiring prior authorization/notification for the applicable timeframes listed above include:

1. Inpatient Admissions (med/surg and behavioral)
2. Elective Procedures
3. Non-covered benefits
4. Medications
5. Transplants
6. SNF/Rehab
7. Fetal Umbilical Artery Doppler Velocimetry CPT Code: 76821
8. Vascular Study (Uterine Artery) CPT Code: 93976
9. Detailed (targeted) ultrasounds: CPT code:76811, 76812

If the requesting provider is NOT in Community’s network, but the servicing provider is part of Community’s network, the requesting provider does not have to request prior authorization for the following services from 2/22/2024 through close of business 3/3/2024. All other services continue to require a prior authorization.

1. CT scans, ECHOs, Ultrasounds (less than a quantity of 3)
2. Outpatient Therapy (physical, occupational, speech) Note: this does not include home health therapy or any services extending past 3/4/2024
3. Wound vacs
4. DMEs except enteral formula, hospital beds
5. Dialysis unless code 90999 is requested (this code requires review)

Note: All services are subject to retrospective review

This message will be updated 3/4/2024