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Utilization Management Archive

2021 Prior Authorization Summary of Changes- Eff 01/01/2021
2021 Prior Authorization Grid -Eff 01/01/2021
2021 Prior Authorization Requirements List - Eff 01/01/2021
2020 Prior Authorization Summary of Changes
2020 Prior Authorization Grid
2020 Prior Authorization Requirements List
2020 Prior Authorization Annual Review Report
2020 Prior Authorization Annual Change Log
2019 Pre Authorization Summary of Changes
2019 Pre Authorization Grid (updated 5/20/2019)
2019 Pre Authorization Grid
2019 Pre Authorization List
2019 Prior Authorization Summary of Changes
2019 Prior Authorization Grid
2019 Prior Authorization Requirements List
2018 eviCore Prior Authorization List
2018 Medicaid Prior Authorization Grid
2017 eviCore Prior Authorization List
2017 eviCore Prior Authorization Grid
2017 LTSS Authorization Request Checklist