CommercialPrior AuthHigh impact
Change in denial process for lack of prior authorization
Harvard Pilgrim Health Care·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 20, 2026
Summary
Point32Health will deny all ancillary and supporting services (including medications) when the primary service is denied for lack of prior authorization, untimely authorization, or failure to meet medical necessity. This applies whether services are billed on the same claim or separate claims.
Action Required
Before July 1, 2026: Billing teams must implement comprehensive prior authorization tracking for all services connected to procedures requiring prior auth. Update billing workflows to flag ancillary services that could be denied if primary service lacks authorization. Train staff to obtain prior authorization for primary procedures before scheduling any related ancillary services, medications, or supporting procedures. Failure to obtain proper authorization will result in denial of ALL related services.