Delay in Implementation of ASC Authorization Changes for Ambetter

Date: 06/11/20

Effective immediately, MHS by Ambetter is delaying the ASC Optimization policy listed below:

• Effective June 1, 2020, Ambetter is making changes to services requiring prior authorization related to Ambulatory Surgeries.
• 80 codes will require authorization if performed in an Outpatient Hospital Setting. (Refer to notice with specific codes and exclusions).
  • Services performed in the provider office or Ambulatory Surgery Center will not require authorization.

Any claims denied for “no prior authorization” for procedure codes listed in policy will be re-processed.

Ambetter will notify providers when a new effective date is set.