CommercialPrior AuthHigh impact
System Now Open and Training Available: New Prior Authorization Requirements for Advanced Imaging (Cardiology and Radiology)
CareFirst BlueCross BlueShield·Cardiology, Radiology·Prior Authorization
Effective date
Aug 2, 2024
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield now requires prior authorization through EviCore for all outpatient advanced imaging services in cardiology and radiology for fully insured commercial plan members. The system is open for prior auth requests effective July 15, 2024, with mandatory authorization required for all services performed August 2, 2024 and beyond.
Action Required
Before August 2, 2024: Billing and scheduling teams must implement new workflow requiring prior authorization through EviCore for all CareFirst commercial members needing outpatient cardiology or radiology advanced imaging. Register for training webinars (July 17, 25, 30, or 31). Update scheduling system to check authorization status before booking imaging appointments. Access EviCore Health Resource Page for specific authorization requirements and clinical guidelines. Claims will be denied without proper authorization for services on/after August 2, 2024.