MedicaidPrior AuthMedium impact
Evolent Prior Authorization Update (PDF)
Ambetter·NH · Pain Management, Radiology, Orthopedics +1 more·Prior Authorization
Effective date
Mar 19, 2026
We identified it
Aug 26, 2026
Summary
Evolent Health has extended the prior authorization timeframe from 30 days to 60 days for Advanced Imaging, Interventional Pain Management (IPM), and Musculoskeletal (MSK) services for NH Healthy Families and Ambetter from NH Healthy Families plans. This change provides a longer approval window for these three service categories, effective March 19, 2026.
Action Required
By March 19, 2026: Billing and clinical teams must update prior authorization submission processes and tracking systems to reflect the new 60-day timeframe (extended from 30 days) for Advanced Imaging, Interventional Pain Management, and Musculoskeletal services submitted to Evolent/Ambetter from NH Healthy Families. Update authorization tracking templates and internal workflows to align with the extended timeline. Inform front desk and authorization staff that these three service categories now have 60 days for approval rather than 30 days. No immediate claim denials are expected, but accurate timeline tracking is critical for follow-up and appeal management.