CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - December 2020
Premera Blue Cross·WA · Radiology, Oncology, Cardiology +11 more·Medical Policy
Effective date
Jan 1, 2021
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical policies effective between January 1 and March 14, 2021, including new prior authorization requirements for advanced imaging, radiation oncology procedures, and various medical devices. The changes also include new drug coverage policies and updated medical necessity criteria for numerous procedures.
Action Required
By March 14, 2021: Billing teams must update prior authorization workflows for AIM Specialty Health Clinical Appropriateness Guidelines affecting advanced imaging (brain, chest, head/neck, oncologic, cardiac), radiation oncology procedures, and newly added pharmacy items. Update billing software to flag procedures requiring prior auth under the reinstated medical policies effective February 5, 2021. Review all 25+ reinstated policies including artificial pancreas devices, cochlear implants, joint arthroplasty, and spinal procedures to ensure medical necessity documentation requirements are met. Failure to obtain required prior authorization will result in claim denials.