CommercialPrior AuthHigh impact
New Prior Authorization Requirements for Cardiology and Radiology Advanced Imaging
CareFirst BlueCross BlueShield·Cardiology, Radiology·Prior Authorization
Effective date
Jul 22, 2024
We identified it
Jun 20, 2026
Summary
CareFirst is partnering with EviCore to require prior authorization for all outpatient cardiology and radiology advanced imaging services for fully insured commercial plan members. Providers must submit authorization requests through EviCore's portal, and services performed without authorization may not be reimbursed.
Action Required
By July 15, 2024: Billing team must register for training webinars and prepare to submit prior authorizations through EviCore portal via CareFirst Direct. Starting July 15, 2024: Begin submitting prior authorization requests for cardiology and radiology advanced imaging services with dates of service July 22, 2024 and later. Update workflow to access CareFirst Provider Portal > Prior Auth/Notification tab > Advanced Imaging for Cardiology and Radiology section. Failure to obtain prior authorization will result in non-reimbursement and providers cannot bill members directly.