CommercialPrior AuthHigh impact
Reminder: Prior Authorization Requirements for Healthy DC Plan Members – Effective April 1, 2026
CareFirst BlueCross BlueShield·DC·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
CareFirst is ending its temporary waiver of prior authorization requirements for Healthy DC Plan members effective April 1, 2026. All services that normally require prior authorization must now obtain approval before providing care to these plan members.
Action Required
By March 23, 2026: Review all scheduled services for Healthy DC plan members with dates of service on or after April 1, 2026, to identify services requiring prior authorization. Use the PAL (Prior Authorization Lookup) tool in the CareFirst Provider Portal starting March 23 to verify specific requirements. Submit all required prior authorization requests electronically through the CareFirst Provider Portal before providing services. Failure to obtain prior authorization will result in claim denials for affected services.