Update to Ambetter Prior Authorization Approval Request Process

Date: 08/10/21

Dear Valued Partner,

At Ambetter of North Carolina Inc., we are always looking for ways to provide a better service for your patient, our member.

In this continued pursuit, there are a few changes we will be making to the Prior Authorization Approval Request process.  We are writing today to inform you of new changes Ambetter of North Carolina Inc. will be implementing effective 11/1/2021.

Home Health Authorization Requirement Changes

In an effort to simplify the home health authorization process overall, we have decided to remove the blanket home health authorization requirements and instead require authorization for the specific codes listed below:

Addition of CPT Codes to Prior Authorization Requirements

The following seven (7) CPT codes will now require prior authorization.  Six (6) of these codes are related to the insertion/implantation of devices, and one (1) code is related to specialized radiation therapy.

Sincerely,

Ambetter of North Carolina Inc.