CommercialPrior AuthHigh impact
Updated Utilization Management Requirements for Cardiac Rehabilitation, Musculoskeletal and Gastroenterological Procedures
CareFirst BlueCross BlueShield·Cardiology, Gastroenterology, Orthopedics +1 more·Prior Authorization
Effective date
Oct 22, 2025
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield is implementing new prior authorization requirements for cardiac rehabilitation, musculoskeletal, and gastroenterological procedures through EviCore starting October 22, 2025. Services performed without prior authorization will be denied and participating providers cannot bill patients directly.
Action Required
By October 8, 2025: Billing team must access CareFirst Provider Portal and register for EviCore's Prior Authorization Portal under Cardiology/Radiology/Gastroenterology/Musculoskeletal section. Before October 22, 2025: Begin submitting prior authorization requests for all cardiac rehabilitation, musculoskeletal, and gastroenterological procedures. Note: Musculoskeletal inpatient procedures require prior auth starting November 10, 2025. Register for training webinars (10/2, 10/16, 10/22, 10/23). Claims will be denied without prior authorization and providers cannot bill patients directly.