Publication Date: 

Please note, this communication only applies to Medicare Advantage Prescription Drug (MAPD) plans offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC). 

Blue Cross NC’s 2022 Evidence of Coverage and Annual Notice of Change documents state that Prior Approval is required for a Physician Specialist, however, we will not be administering this requirement for 2022. 

In addition, the following services will not require prior approval: 

  • Chiropractic services 
  • Physical therapy 
  • Occupational therapy 
  • Diagnostic radiological services 
  • Therapeutic radiological services 

Clarification letters about 2022 Prior Approval were mailed to members immediately following the mailing of the Annual Notice of Changes, in late September. 

If you receive questions from your Blue Medicare Advantage patients about prior approval requirements, please share this information with them or advise them to call the Customer Service number on the back of their ID card.