CommercialPrior AuthHigh impact
Update to Prior Authorization Requirements for Healthy DC Plan Members – Effective April 1, 2026
CareFirst BlueCross BlueShield·DC·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Starting April 1, 2026, CareFirst will end the temporary waiver of prior authorization requirements for Healthy DC plan members. All services requiring prior authorization must be approved through standard CareFirst procedures before being rendered.
Action Required
By March 23, 2026: Use the Prior Authorization Lookup (PAL) tool in CareFirst Provider Portal to verify which services require prior auth for Healthy DC members. Submit electronic prior authorization requests through CareFirst Provider Portal for all services with dates of service on/after April 1, 2026. Review all scheduled services for Healthy DC members after April 1st to determine prior auth requirements. Claims will be denied without proper prior authorization.