CommercialPrior AuthMedium impact
Medical Policy and Coding Updates - January 2024
Premera Blue Cross·WA · Oncology, Radiology, Cardiology +4 more·Medical Policy
Effective date
Apr 14, 2024
We identified it
Jun 18, 2026
Summary
Carelon Medical Benefits Management (formerly AIM Specialty Health) updated clinical appropriateness guidelines for radiation therapy, advanced imaging, genetic testing, and therapeutic radiopharmaceuticals. Key changes include new IMRT indications for colon cancer, modified cardiac imaging criteria, expanded cancer screening parameters, and updated genetic testing restrictions.
Action Required
By April 14, 2024: Prior authorization staff must review and update pre-certification processes for radiation therapy (IMRT for colon cancer, stereotactic body radiotherapy for hepatocellular carcinoma), advanced imaging requests (cardiac CT, abdominal/pelvic imaging, brain imaging), and genetic testing orders. Update prior auth checklists to reflect new eligibility criteria and documentation requirements. Verify Carelon guidelines are current in authorization systems to prevent claim denials.