Effective Jan. 1, 2016: Prior Auth Required for Attended Sleep Studies

December 17, 2015 - Effective Jan. 1, 2016, CareFirst is implementing a Prior Authorization requirement for attended sleep studies performed in a sleep lab, office or hospital setting.

What does this mean for you?

• Reimbursement will no longer be provided for attended sleep studies unless a Prior Authorization has been obtained.
• Prior Authorization for attended sleep studies will only be provided if the site of care is medically necessary.
• You cannot balance bill our members for unauthorized services.
• Unattended (home) sleep studies will not require a Prior Authorization.

To request a Prior Authorization, log in at www.carefirst.com/providerlogin and click the Prior Authorization/Notifications tab to begin your request.

Note: Medicare Primary and FEP PPO are out-of-scope for this requirement.

Learn More

To learn more about submitting Prior Authorization requests, register for an upcoming webinar at www.carefirst.com/cpet.