CommercialPrior AuthMedium impact
Medical Policy and Coding Updates - July 2024
Premera Blue Cross·WA · Radiology, Cardiology, Neurology +2 more·Medical Policy
Effective date
Oct 20, 2024
We identified it
Jun 16, 2026
Summary
Premera updated multiple Carelon Medical Benefits Management clinical guidelines effective October 20, 2024, covering radiology, cardiology, genetic testing, radiation oncology, and sleep medicine. These updates expand coverage criteria for certain imaging studies (including Alzheimer's MRI/PET scans), genetic testing, and sleep disorder treatments while clarifying documentation requirements and removing some coverage options.
Action Required
Before October 20, 2024: Prior authorization staff must review updated Carelon Medical Benefits Management guidelines for radiology, cardiology, genetic testing, radiation oncology, and sleep medicine. Update prior authorization protocols to reflect new coverage criteria including expanded MRI indications for Alzheimer's disease, updated echocardiography frequency for mavacamten patients, and revised genetic testing requirements. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for specific guideline questions and download current guidelines from their portal.