October 30, 2026

We are issuing this reminder regarding prior authorization requirements for Medical Nutritional Support.

As outlined in our Provider Manual and Medical Nutritional Support policy, prior authorization is required before services are rendered. This requirement is not new and remains part of our established coverage guidelines.

To ensure claims are processed appropriately and in accordance with plan requirements, providers must obtain prior authorization before submitting claims.

Effective December 1, 2026, claims submitted without the required authorization will be denied.

Note: If the authorization includes the BO modifier (enteral nutrition by mouth), the claim must also include the modifier to be considered for reimbursement.

For more information about prior authorization requirements including impacted billing codes, please refer to the Medical Nutritional Support policy (MN.018.A) in our policy bulletin library at JeffersonHealthPlans.com/PolicyBulletins.

When requesting prior authorization, utilize our provider portal. For instructions, review the prior authorization portal guide at JeffersonHealthPlans.com/Provider-Portal.