Medicare AdvantagePrior AuthHigh impact
MAPAP302 - Carelon Prior Authorization - Updated to include changes to other benefit management program
Blue Cross of Idaho·ID · Diagnostic Imaging, Radiology, Nuclear Medicine·Prior Authorization
Effective date
Jun 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their Carelon Prior Authorization policy for Medicare Advantage members, expanding prior authorization requirements to include genetic testing services in addition to existing advanced imaging requirements. The policy clarifies submission processes and adds new contact information for peer-to-peer reviews.
Action Required
Immediately: Update prior authorization workflows to include genetic testing services for Blue Cross of Idaho Medicare Advantage members. Billing team must verify PA requirements using the Prior Authorization Procedure Code Lookup Tool before scheduling. Update staff training to include new Carelon peer-to-peer review phone number (866-972-9842). Ensure authorization numbers are included on all claims for advanced imaging (MRI/MRA, CT, PET, nuclear cardiology) and genetic testing. Failure to obtain prior authorization will result in claim denials with limited retrospective review options.