Dec. 1, 2025
We’re reviewing some prior authorization exemptions for particular health care services in effect for at least one year to determine if the prior authorization exemption can be continued. We may contact you requesting medical records for this review. Be sure to promptly reply to requests for medical records.
Review method: We randomly select at least five claims processed after your prior authorization exemption was in effect.
- If at least 90% of those claims were medically necessary, then the prior authorization exemption will be renewed for that particular service.
- If we found less than 90% of those claims were medically necessary, your prior authorization exemption will be rescinded.
Your reviewed results will be available on Availity® Essentials Payer Spaces in the Provider Correspondence Viewer starting Jan. 30, 2026. If you provided an alternate email/mail communication method for prior authorization exemptions, your notice was also sent via that method.
For more information, refer to the Prior Authorizations Exemptions page.
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