All PlansAdministrativeHigh impact
Medical Policy and Coding Updates - November 2018
Premera Blue Cross·WA · Oncology, Neurosurgery, Orthopedics +5 more·Medical Policy
Effective date
Dec 6, 2018
We identified it
Jun 18, 2026
Summary
Comprehensive medical policy updates affecting multiple specialties with various effective dates from December 2018 through July 2019. Key changes include new genetic testing review processes through AIM Specialty Health starting January 4, 2019, updated radiation oncology and cardiology guidelines effective January 28, 2019, and new pharmaceutical criteria for various oncology and specialty drugs.
Action Required
By January 4, 2019: Billing team must update genetic testing submission processes to route through AIM Specialty Health instead of Premera direct review - update workflows and staff training. By January 28, 2019: Review and update radiation oncology and cardiology prior authorization criteria per new AIM guidelines - modify billing software rules for IMRT, SBRT, and cardiac imaging services. By February 1, 2019: Update cervical spine surgery coding and documentation requirements for discectomy, laminectomy, and fusion procedures. Pharmacy team must implement new prior authorization criteria for multiple oncology drugs and update quantity limits for HIV medications.