In-Network Provisions Extended Through September

To support providers during the recent COVID-19 surge, the policy for in-network provider provisions has been extended

To support providers during the recent COVID-19 surge, the Department and the prepaid health plans (PHPS) agreed to extend the policy for in-network provider provisions originally scheduled to expire on Aug. 30, 2021. The PHPs will implement the following:

Between Aug. 31, 2021, and Sept. 30, 2021, medically necessary services that normally require prior authorization (PA) will still be reimbursed at either 100% of fee-for-service rates (for out-of–network providers) or the contracted rate (for in-network providers) when PA is obtained following the service provision. To ensure that providers fully understand each PHP’s prior authorization requirements during the transition, the PHPs will still process and pay for these services if:

  • a provider fails to submit prior authorization prior to the service being provided and submits prior authorization after the date of service, or 
  • a provider submits for retroactive prior authorizations. This exception does not apply to concurrent reviews for inpatient hospitalizations which should still occur during this time period.

Additional details about each PHP’s required authorizations are available at:  

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