Effective September 15, 2026: Prior Authorization Requirement Update for PT, OT and SLP Services for CareFirst BlueCross BlueShield Medicare Advantage

By September 15, 2026: Billing team and clinical staff must implement the following changes: (1) Update billing software and intake workflows to require prior authorization submission for ALL PT, OT, and SLP services for CareFirst BlueCross BlueShield Medicare Advantage members with dates of service on or after 9/15/2026; (2) Train front desk and scheduling staff to verify member eligibility and prior authorization requirements using the CareFirst Provider Portal Prior Authorization Lookup (PAL) tool BEFORE scheduling appointments; (3) Update provider encounter templates and clinical documentation requirements to ensure all medical necessity supporting documentation is collected and ready for prior authorization submission; (4) Establish a process for billing team to submit prior authorization requests electronically through CareFirst Direct portal before services are rendered; (5) Configure billing system to flag claims for these service types if prior authorization is not documented; (6) Communicate deadline to all PT, OT, and SLP providers in the practice. Failure to obtain prior authorization will result in claim denials and non-payment.