Update regarding suspension of certain prior authorization and utilization management requirements
Anthem Blue Cross and Blue Shield (Anthem) is closely monitoring COVID-19 developments and what they mean for members and healthcare providers. In response to a directive issued by the Georgia Department of Insurance (DOI) on December 31, 2020, they have suspended select prior authorization requirements and utilization management reviews. Anthem will implement these requirements for 30 days from the effective date to allow healthcare providers to focus on caring for patients diagnosed with COVID-19.
These temporary suspension actions will impact individual, employer-based fully insured and self-insured/administrative services only (ASO) and include:
- Suspension of prior authorization for urgent or nonelective inpatient surgeries or admissions
- Suspension of concurrent reviews for inpatient hospital stays
Utilization review for elective and nonurgent surgeries are still subject to review. While the DOI guidance directs insurers to suspend concurrent reviews for inpatient hospital stays, retrospective reviews may still be conducted.
Opt-out options for ASO plans
If employers that offer self-funded plans with participants in Georgia do not desire to implement these suspension actions, they must notify their Anthem sales account representative with their intention to opt-out by Tuesday, January 19, 2021. If an opt-out request is not received by the noted deadline, Anthem will implement the suspension actions provided in the directive.
If you have questions, please contact your Anthem sales account representative.
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