MedicaidPrior AuthMedium impact
Authorization Updates - Effective November 1, 2026
Sentara Health Plans·VA · Psychiatry, Pain Management·Prior Authorization
Effective date
Nov 1, 2026
We identified it
Jul 21, 2026
Summary
Effective November 1, 2026, Sentara Health Plans will require prior authorization/precertification for buprenorphine implant (J0570, 74.2mg) for all Medicaid products in Virginia. Billing teams must obtain authorization before submitting claims for this code to avoid denials.
Action Required
By October 31, 2026: Billing team must update prior authorization protocols in the billing system to require authorization for HCPCS code J0570 (Buprenorphine Implant, 74.2mg) for all Virginia Medicaid patients. Providers and clinical staff should be notified that this code now requires precertification through Sentara Health Plans before administration. Update encounter forms and standing orders to flag this code for authorization requests. Implement a tracking system to ensure all J0570 claims have authorization documentation attached. Claims submitted without prior authorization will be denied by Sentara Health Plans.