Pre-authorization list changes slated for
August 1 for HIP Commercial & Medicaid members
Beginning August 1, 2019, for HIP’s Commercial and Medicaid lines of business, we will supplement our current utilization management pre-authorization list with 99 codes (27 current and 72 new) that have site-of-service rules. All other codes remain unchanged, and will continue to apply to all members. The site-of-service rules identify procedures that do not require a pre-authorization if performed in certain office settings (POS 11) or in an ambulatory surgery center (POS 24). To help you find our pre-authorization rules, we added a new section to
The same rules apply to all managing entities (HIP, Montefiore CMO, and HealthCare Partners) and delegates who conduct utilization management on our behalf.