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Medical Policy and Coding Updates - October 2019
Premera Blue Cross·WA · Orthopedics, Cardiology, Oncology +3 more·Medical Policy
Effective date
Nov 10, 2019
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical policies effective in multiple phases from November 2019 through January 2020, including new drug coverage criteria, revised imaging guidelines, and updated procedures for joint replacement, cardiac devices, and oncology treatments. Key changes include expanded coverage for rare disease drugs, updated criteria for hip/knee arthroplasty, and revised AIM Specialty Health imaging guidelines.
Action Required
By December 5, 2019: Billing team must review and update prior authorization requirements for C5 complement inhibitors and steroid-eluting sinus stents. By January 1, 2020: Update coverage criteria for hip arthroplasty and total joint replacement procedures, ensuring proper documentation of medical necessity. By January 3, 2020: Verify coverage for newly added rare disease drugs and update oncology drug prior authorization processes. Review AIM Specialty Health imaging guidelines effective November 10, 2019 for cardiac, head/neck, oncologic, and vascular imaging to ensure proper prior authorization.