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Commercial Prior Authorization Summary/Code List Archive

This page includes the previous prior authorization summaries and code list documents that were posted at the end of the year.

2024 Prior Authorization Requirements - Summary of Services
2024 Commercial Outpatient Benefit Prior Authorization Behavorial Health Procedure Code List
2024 Commercial Outpatient Medical Surgical ASO Prior Authorization Codes
2024 Commercial Outpatient Benefit Prior Authorization Fully Insured Medical Surgical Procedure Code List
2024 Commercial Specialty Pharmacy Prior Authorization Drug List

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