All PlansPrior AuthMedium impact
Myoelectric and Microprocessor Prosthetic and Orthotic Components for the Upper Limb
Regence BlueShield·Gastroenterology, Pediatrics, Family Medicine +1 more·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
There is a major discrepancy in this policy document. The title indicates it covers prosthetic/orthotic components for upper limbs, but the actual content is about enteral and oral nutrition therapy in home settings. This policy establishes prior authorization requirements for home enteral nutrition formulas, supplies, and pumps with specific medical necessity criteria.
Action Required
Before July 1, 2026: Billing team must implement prior authorization requirements for home enteral nutrition services. Update billing system to flag enteral nutrition claims for prior auth verification. Create documentation checklists for providers covering medical necessity criteria including severe intestinal malabsorption, permanent nonfunction of digestive structures, neuromuscular disorders with aspiration risk, failure to thrive, and inborn errors of metabolism. Train staff on 6-month initial authorization periods and re-authorization requirements. Note: Verify this policy content matches the stated title about prosthetic/orthotic components.