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Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on Nov. 1, 2024
Act
by Oct 31, 2024
Effective date
Nov 1, 2024
Identified
Nov 1, 2024
Summary
Presbyterian Health Plan is updating its Medical Policy Manual and Prior Authorization Guide effective November 1, 2024, adding new procedures, modifying existing ones, and retiring three procedures (Autologous Chondrocyte Implantation, Meniscal Allograft Transplant, Thoracic Spinal Surgeries, and Unicompartmental Knee Replacement). Billing teams must verify prior authorization requirements for all affected procedures using Presbyterian's updated resources and tools.
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What to do
by Oct 31, 2024 · 6 steps
01Billing team must review the full Summary of Updates document at https://onbaseext.phs.org/PEL/DisplayDocument?ContentID=PEL_00957317 to identify specific prior authorization requirement changes for each procedure.
02Update internal prior authorization workflows and billing system rules to reflect the 14 modified/retired procedures listed.
03Immediately STOP requesting prior authorizations for the four retired procedures (Autologous Chondrocyte Implantation, Meniscal Allograft Transplant, Thoracic Spinal Surgeries, Unicompartmental Knee Replacement) to prevent unnecessary claim delays.
04Verify the new acupuncture, bariatric surgery, genetic testing, and radiation oncology requirements using the Prior Authorization Check Tool (https://prescoverage.phs.org/ac/) and Medical Policy Manual (www.phs.org/providers/resources/medical-policy-manual).
05Update encounter forms and clinical documentation templates to reflect new prior authorization triggers.
06Train all providers and front desk staff on the changes.
If missed: Failure to obtain required prior authorizations will result in claim denials; submitting prior auth for retired procedures may delay processing.
Original notice
Presbyterian Will Update Its Medical Policy Manual and Prior Authorization Guide on Nov. 1, 2024
onbaseext.phs.org · Always check the source before changing claims.
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