Provider Monthly: New authorization tool, updated drug fee schedules, and revised medical policies in August 2021

Featured Story:

Five tips to ensure providers’ success with new Authorization Process for High-Tech & Cardiac Imaging

Providers: effective July 18, 2021, there was a new Authorization Process for High-Tech & Cardiac Imaging implemented on our authorization tool. To ensure you're maximize the benefits of this new tool, we've outlined some tips below to reduce your administrative burden and speed up authorization approvals.

  1. Select the appropriate requested service
    When you are using the prior authorization tool, confirm that you are selecting the proper service—and not choosing the default of other medical. Indicating an accurate service that corresponds with your request only speeds up the process.

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In this issue:

  • AllWays Health Partners’ Drug fee schedules to be updated
  • Hospital inpatient utilization report
  • Revised medical policies
  • Code updates
  • Formulary updates

AllWays Health Partners’ Drug fee schedules to be updated

AllWays Health Partners reviews its drug fee schedules quarterly to ensure that they are current, comprehensive and consistent with industry standards, to the extent supported by its systems. In most cases, changes involve adding fees for new or existing codes, to supplement the fees already on the fee schedule.

The next update will occur on October 1, 2021. Changes may involve both new and existing CPT and HCPCS codes, and will include the planned quarterly update to physician administered drugs, immune globulin, vaccine and toxoid fees.

Hospital inpatient utilization report

The latest quarterly hospital inpatient utilization report is now available. To review this report, click on the Reports tab in the Provider Portal and select Clinical Reports. If you do not have access to the Provider Portal, you may register online at

Medical Policy Updates -August 1, 2021 Effective Date

Four medical policies were reviewed and passed by the AllWays Health Partners Medical Policy Committee. These policies are now posted to

The table below is a summary of the policies and the changes:

For more information or to download our medical policies, go to and select the policy under the medical policy listings.

Code Updates

CPT Code Updates
As a reminder to our network the following service is not covered across all lines of business:

Formulary updates

Effective date: 10/01/2021

Updates for Commercial Members
The following changes are being made to the listed medications: