Evolent Musculoskeletal Program Updates Effective Dec 15, 2026

Before December 15, 2026: Billing and authorization staff must update workflows to comply with Evolent's mandatory site-of-care selection process. (1) Train all ordering providers and authorization requesters on the new requirement to select preferred site of care (outpatient vs. inpatient) when submitting authorization requests for shoulder, hip, knee, and spine surgeries for Ambetter from Meridian members. (2) Update authorization submission procedures to require site-of-care selection at intake; if inpatient is selected for procedures appropriate for outpatient, providers must either choose from allowable exceptions or submit clinical justification documentation. (3) Notify providers to reference RadMD for Evolent Place of Service Policy 1773 Musculoskeletal Surgery. (4) Configure billing system to flag authorizations for these procedures and ensure final authorization documentation includes both procedure and site-of-care determinations before claims submission. Failure to follow site-of-care guidance may result in authorization denials or claim rejections. Contact your Provider Engagement representative for questions.