CommercialPrior AuthMedium impact
00.01.25bs, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Independence Blue Cross·Radiology, Physical Therapy, PM&R (Physical Medicine & Rehab)·Network
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
This policy establishes PPO network rules for specialty services including durable medical equipment (DME), laboratory, radiology, and physical medicine/rehabilitative services. The billing team must verify network participation requirements and prior authorization rules for these service categories when processing claims effective April 1, 2025.
Action Required
By April 1, 2025: Billing team must review the full policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=04&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-00-01-25bs to identify specific network participation and prior authorization requirements for DME, laboratory, radiology, and PM&R services. Update billing system rules and provider encounter forms to enforce network verification and obtain prior authorizations as required by this policy for commercial PPO plans. Communicate requirements to providers and front desk staff. Non-compliance may result in claim denials or out-of-network reimbursement.