CommercialPrior AuthMedium impact
11 Medications Added to the Prior Authorization List – Effective 9/1/19
CareFirst BlueCross BlueShield·Prior Authorization
Effective date
Sep 1, 2019
We identified it
Jun 20, 2026
Summary
Effective September 1, 2019, CareFirst added 11 medications to their prior authorization list for medical benefit drugs administered in outpatient hospital, home, or office settings. Claims for these medications will be denied if prior authorization is not obtained through the Provider Portal.
Action Required
Before September 1, 2019: Billing team must identify the 11 specific medications added to CareFirst's prior authorization list and update workflow to require prior auth requests through the Provider Portal at carefirst.com/providerlogin under the Prior Auth/Notifications tab. Update staff procedures for outpatient hospital, home, and office medication administration. Failure to obtain prior authorization will result in claim denials.