Meridian Health Plan to Require Prior Authorization for Out-of-Network Providers

Meridian Health Plan has announced a significant policy change that will directly impact medical billing and reimbursement for out-of-network services. Effective May 1, 2025, all out-of-network providers must obtain prior authorization before rendering services to Meridian members.

Key Impacts on Medical Billing:

• Claims Denials & Delays: Claims for out-of-network services without prior authorization may be denied, leading to delayed reimbursements and increased administrative work.
• Billing Workflow Adjustments: Billing teams must coordinate with providers to obtain prior authorization before services are performed, reducing rejected claims.
• Revenue Cycle Management Considerations: Practices that frequently bill Meridian for out-of-network services must adapt their processes to comply with this new requirement to avoid payment disruptions.

Some exclusions apply. For further details, visit Meridian’s official provider bulletin or contact their Provider Services department.

Contact Yeo & Yeo Medical Billing & Consulting for additional guidance on how these changes may impact your practice.