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BLUECONNECT
Providers
December 2024
In This Issue
► December news: Executive summary
► AZ Blue welcomes Banner Children's to MaricopaFocus Network
► FEP offers new Postal Service plans for 2025
► Changes for Medicare Advantage prior auth and step therapy start January 1
► How to validate eligibility without an ID card
Changes for Medicare Advantage prior auth and step therapy start January 1
We’ve reviewed, revised, and refined our Medicare Advantage (MA) prior authorization code list. The new 2025 list reflects the following goals for greater efficiency:
• Decrease the overall volume of your prior auth requests
• Remove codes for commonly rendered services that almost always get approved
• Reduce the risk of post-service claim reviews that could result in denials
• Align with CMS recommendations for prior auth requirements
• Streamline code ranges so all related codes for a particular service are included in the list
• Add codes for high-cost DME, neurostimulators, and high-cost medications that increase member costs
• Synchronize as much as possible with our commercial code list
Part B Step Therapy for 2025
All of the nonpreferred drugs and many of the preferred drugs in our Part B Step Therapy program require prior authorization. Be sure to check out our 2025 list to see how we’ve expanded the program to include drugs and indications for oncology. You may notice that the preferred biosimilars are different from the commercial list referenced in the November article on biosimilars.
Reminder: Our 2025 prior auth and step therapy program changes apply only to the MA plans we administer. Check the back of the ID card to see who takes care of claims and utilization management for the member’s plan. It could be AZ Blue, Optum Health Network Arizona (OHNAZ), or Arizona Priority Care (AZPC).
You can preview the 2025 MA code list and step therapy list on our MA provider resource page. If you have questions about the updates, feel free to contact your Provider Relations Contact or call us at 1-844-995-2583.
In This Issue
► December news: Executive summary
► AZ Blue welcomes Banner Children's to MaricopaFocus Network
► FEP offers new Postal Service plans for 2025
► Changes for Medicare Advantage prior auth and step therapy start January 1
► How to validate eligibility without an ID card
Blue Cross, Blue Shield, and the Cross and Shield Symbols are registered service marks of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

Optum Health Network of Arizona (OHNAZ) and Arizona Priority Care (AZPC) are separate, independent companies contracted with AZ Blue to provide utilization management and claim/payment processing services for providers and attributed members with certain AZ Blue Medicare Advantage HMO plans.

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