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August 29, 2023

Beginning Jan. 1, 2024, we're offering ASO groups an optional pre-authorization (PA) requirement for coverage of specific cardiac procedures. Services included in this PA requirement include certain pacemakers, cardiac resynchronization therapy, coronary angiography, percutaneous coronary interventions, arterial ultrasounds and peripheral revascularization. This option is an add-on, available only to groups that purchase the Advanced Imaging Authorization program.

Adding PA will help ensure providers are following the standard of care for the specific service requested and avoid unnecessary and potentially more invasive procedures and their associated costs.

In addition, PA supports our commitment to improving clinical appropriateness of cardiac services delivered to members. The burden of PA lies with the provider, and, if in-network, members can't be balance billed. Implementation of this and other similar PA programs is transparent to the member.

We added the same PA requirement for specific cardiac services for fully insured groups effective Jan. 1, 2023.

For more information about this and other optional utilization management solutions available to ASO groups, please contact your account representative.

To review other PA programs we’ve implemented this year, please see We’re expanding site-of-service reviews to provide members access to high-value care and Joint site-of-care redirection added to Physical Medicine program.