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Authorization Updates - Effective November 1, 2026
Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
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.
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What to do
by Oct 31, 2026 · 5 steps
01Billing 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.
02Providers and clinical staff should be notified that this code now requires precertification through Sentara Health Plans before administration.
03Update encounter forms and standing orders to flag this code for authorization requests.
04Implement a tracking system to ensure all J0570 claims have authorization documentation attached.
05Claims submitted without prior authorization will be denied by Sentara Health Plans.
Codes mentioned
J0570
Original notice
Authorization Updates - Effective November 1, 2026
shc-p-001.sitecorecontenthub.cloud · Always check the source before changing claims.