Starting Dec. 9, submit new or corrected claims when you get a retroactive authorization after a claim denial

There will soon be a new requirement for claims processing when a retroactive authorization has been granted after a claim denial.

What’s changing?

Starting Dec. 9, 2024, we’ll require you to submit a claim for payment if a retroactive authorization is approved after a claim has denied (fully or partially) for no authorization:

• Claim denied in full—submit a new claim
• Claim partially denied—submit a corrected claim with the authorization number listed in the notes section

What’s not changing?

Our medical authorization appeals process isn’t changing. If you appeal a denied authorization request and we grant a retroactive authorization during this appeals process, there’s no need to submit a new claim if a claim had previously been denied. Our teams will continue to reprocess these denied claims for payment automatically.