CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - July 2021
Premera Blue Cross·WA · Orthopedics, Neurosurgery, Radiology +8 more·Medical Policy
Effective date
Sep 12, 2021
We identified it
Jun 18, 2026
Summary
Premera Blue Cross has updated multiple medical policies effective at various dates, including new investigational designations for nerve repair procedures, extensive changes to AIM Specialty Health imaging guidelines requiring more conservative management and radiographs before advanced imaging, and addition of new drug coverage policies for rare diseases and hormonal treatments.
Action Required
By September 12, 2021: Billing and clinical teams must update prior authorization processes for all advanced imaging (MRI, CT) to ensure radiographs are performed first and conservative management requirements are met per new AIM Specialty Health guidelines. Update EMR templates to include required documentation for imaging justification. By October 1, 2021: Flag nerve repair procedures using synthetic conduits or allografts as investigational - verify coverage before scheduling. Review and update drug formulary access for newly covered medications including GnRH analogs and rare disease treatments.