What types of policy changes does BCBS Texas issue?

BCBS Texas regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does BCBS Texas update its policies?

BCBS Texas typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many BCBS Texas policy changes are tracked here?

This page currently tracks 50 documented BCBS Texas policy changes. New items are added as they are identified.

What should I do when BCBS Texas changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

PAYER POLICY CHANGES

BCBS Texas Policy Changes & Prior Auth Updates

We track 50 documented policy changes from BCBS Texas across TX. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original BCBS Texas notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new BCBS Texas updates by email (daily or weekly, your choice, on every plan).

BCBS Texas · Effective Dec 1, 2026High impact
New Claims Editing Rules To Be Implemented in December 2026
Blue Cross Blue Shield of Texas is implementing new claims editing rules effective December 1, 2026, that will enforce specific unit limits on five specialty injectable drugs (Denosumab, Aflibercept, Ranibizumab, Pasireotide, and Ranibizumab-eqrn) and require proper application of drug wastage modifiers on single-use vial claims. Claims that fail these edits will receive ineligible reason codes beginning with 'G.' Billing teams must update systems and provider education to comply with these new frequency and unit limitations.
BCBS Texas · Effective Dec 21, 2026High impact
Prior Authorization Changes for Some Government Program Members
Blue Cross and Blue Shield of Texas is removing prior authorization requirements for specific service categories (laboratory analyses, drugs/biologics, molecular pathology, infectious disease testing, radiology, advanced imaging, orthopedic surgery, foot and ankle surgery, plastic/reconstructive surgery, vascular surgery, organ transplant, general surgery, ophthalmology, and miscellaneous specialty procedures) for Medicare Advantage members effective December 21, 2026. Additionally, the plan will begin reducing and eventually eliminating the 'Recommended Clinical Review' option from utilization management processes for most commercial members by end of 2027, with ERS and TRS excluded from this change.
BCBS Texas · Effective Jan 1, 2027High impact
Spinal Fusion Surgery Prior Authorization Requirements Changing for TRS Participants
Effective January 1, 2027, Blue Cross and Blue Shield of Texas will assume prior authorization processing for spinal fusion surgery for TRS participants, replacing Carelon. Prior authorization approval now requires documentation that the participant completed a minimum of six consecutive weeks of physical therapy prescribed by a physician within 12 months of the procedure, and the physical therapy must occur in an office setting or approved online treatment.
BCBS Texas · Effective Jan 1, 2027High impact
New Digital Interfaces To Simplify Prior Authorization Requests
Effective January 1, 2027, this BCBS insurer will launch new API-based digital interfaces to streamline prior authorization requests and enable real-time access to patient data within your EHR system. This CMS-mandated change applies to Medicare Advantage, Medicaid, and select commercial members, requiring providers to integrate new digital tools to determine authorization requirements, access patient information, and track request status.
BCBS Texas · Effective Jan 1, 2027High impact
Watch for New Edge Benefit Plan Members in 2027
Beginning January 1, 2027, Blue Cross and Blue Shield of Texas will introduce new Edge benefit plans (powered by Easify) that are copay-only PPO plans with tiered copay benefits based on provider selection. Billing teams must verify member ID cards, confirm copay amounts through Availity Essentials before appointments, and ensure rendering provider NPIs are included on all claims.
BCBS Texas · Effective Jan 1, 2027High impact
We’ll Begin Removing Recommended Clinical Review as an Optional Medical Necessity Review, Effective Jan. 1, 2027
Effective January 1, 2027, Blue Cross and Blue Shield of Texas will eliminate 'recommended clinical review' as an optional medical necessity review option for commercial members. Services that previously allowed recommended clinical review will require prior authorization instead. This change will be fully implemented by the end of 2027.
BCBS Texas · Effective Jan 1, 2027Medium impact
Changes Coming to the Medical Drug Benefit Program
Effective January 1, 2027, Blue Cross and Blue Shield of Texas will expand its Medical Drug Benefit Program to update coverage for specific prescription drugs administered by healthcare providers in clinical settings. This affects coverage determinations for therapeutic alternatives, newly FDA-approved drugs, FDA-accelerated approval drugs, and drugs with limited medical benefit coverage. The policy applies to commercial members only and does not affect Medicaid, HMO, Federal Employee Program, or Postal Employee Program members. Billing teams must verify eligibility and prior authorization requirements through Availity Essentials or preferred vendors before service delivery.
BCBS Texas · Effective Jan 1, 2027Medium impact
Updates to Behavioral Health Substance Abuse Criteria for Utilization Management
Effective January 1, 2027, Blue Cross and Blue Shield of Texas will expand its use of ASAM (American Society of Addiction Medicine) Criteria 4.0 for medical necessity reviews of substance abuse and behavioral health services to include adolescents, in addition to the existing adult coverage. This standardizes utilization management criteria across age groups for addiction treatment services.
BCBS Texas · Effective Feb 1, 2027Medium impact
Enhanced Review of Laboratory, Genetic and Molecular Testing Claims
Effective February 1, 2027, Blue Cross and Blue Shield of Texas will implement enhanced claims review for laboratory, genetic, and molecular testing services. All such claims will be reviewed by Concert (a contracted healthcare technology company) against American Medical Association and Centers for Medicare & Medicaid Services National Correct Coding Initiative guidelines to ensure proper coding alignment. Denied claims will receive notification with next steps.
BCBS Texas · Effective Nov 1, 2026High impact
We’ll Conduct coordination of Benefit Reviews for Medicaid Claims to Identify Potential Overlaps in Coverage
Effective November 1, 2026, Blue Cross and Blue Shield of Texas will conduct postpayment coordination of benefit (COB) reviews for Medicaid claims using Machinify to identify overlaps in coverage. If a claim was paid but another insurer is determined to be primary, BCBSTX will recover the overpayment. This affects claim adjudication processes and requires awareness of potential retroactive recovery actions.
BCBS Texas · Effective Oct 2, 2026High impact
Reminder: We’ll Conduct Postpayment Reviews on Medicaid Claims
Beginning October 2, 2026, Medicaid will conduct postpayment reviews of claims to identify billing inconsistencies, coding errors, and reimbursement policy misalignment. Reviews will examine current claims, historical claims from January 1, 2026 onward, and prospective claims. Based on findings, the payer may request refunds or apply adjustments to future payments.
BCBS Texas · Effective Oct 1, 2026High impact
Prior Authorization Changes for Some Commercial and Government Program Members
Blue Cross Blue Shield of Texas is restructuring prior authorization requirements for commercial, Medicare Advantage, and Medicaid members effective October 1, 2026 and January 1, 2027. Changes include shifting specific procedure codes (medical oncology drugs, genetic testing, orthotics, wound care, DME, neurostimulator sleep services) between utilization management vendors (Carelon, BCBSTX, EviCore) and removing the 'Recommended Clinical Review' option by end of 2027. Billing teams must verify current prior authorization requirements through Availity before rendering services, as prior auth vendor assignments and requirements are changing significantly.
BCBS Texas · Effective Oct 1, 2026High impact
Prior Authorization Changes for Some Members
Blue Cross and Blue Shield of Texas is removing prior authorization requirements for musculoskeletal codes previously reviewed by Carelon and removing select outpatient services codes previously reviewed by BCBSTX for commercial members. These changes take effect October 1, 2026, and require billing teams to verify current prior authorization requirements through Availity Essentials before rendering services.
BCBS Texas · Effective Sep 18, 2026High impact
Learn About Enhancements to Medicaid Utilization Management Process, Effective Sept. 18, 2026
Blue Cross and Blue Shield of Texas is launching a new Medicaid Authorizations application within Availity Essentials effective Sept. 18, 2026, streamlining prior authorization and notification requests for Texas Medicaid members. Billing teams will now check authorization requirements in real-time, submit requests 24/7, upload documentation online, and track status immediately through an integrated workflow—replacing traditional phone, fax, and paper processes.
BCBS Texas · Effective Sep 1, 2026High impact
TRS Participants Have Updated Plans
Effective September 1, 2026, TRS-ActiveCare plans have updated network codes, alpha prefixes, group numbers, and tiered benefit designs with new participant cost sharing that may vary by selected primary care physician, specialist, or facility. Billing teams must verify current eligibility and benefits before every appointment using Availity Essentials or preferred vendors to ensure accurate claim processing and proper patient notification of coverage.
BCBS Texas · Effective Aug 1, 2026High impact
Prior Authorization Changes for Some Commercial and Government Program Members
Blue Cross and Blue Shield of Texas is implementing prior authorization requirement changes for commercial and government program members, effective in two phases: October 1, 2026 for commercial members (adding radiology, sleep, molecular genetic lab, medical oncology, and drug codes to utilization management review) and August 1, 2026 for Medicare Advantage members (implementing Part B Step Therapy Program and adjusting code reviews). Billing teams must verify which utilization management vendor (Carelon, EviCore, or BCBSTX) handles each service type and obtain prior authorization accordingly.
BCBS Texas · Effective Jul 15, 2026High impact
New Claims Editing Rules To Be Implemented in July 2026
Blue Cross Blue Shield of Texas is implementing new claims editing rules in July 2026 that will automatically deny or rebundle claims for various coding scenarios. Claims receiving these edits will show ineligible reason codes with an alpha character 'G' and affect multiple specialties including radiation therapy, STI testing, colonoscopy procedures, and hospital billing.
BCBS Texas · Effective Jul 1, 2026High impact
Register for Webinar on Coding for Evaluation and Management Claims
Effective July 1, 2026, BCBS Texas refined its claims editing and review process for office, inpatient, and outpatient evaluation and management (E/M) services for commercial members. The insurer is offering three educational webinars in October 2026 to train providers on these coding changes. Billing teams must attend or review the updated CPCP024 policy to understand the new requirements and avoid claim denials.
BCBS Texas · Effective Jul 1, 2026High impact
Claim Editing Changes for Evaluation and Management Services for Commercial Members, Effective July 1, 2026
Effective July 1, 2026, Blue Cross Blue Shield of Texas will implement enhanced claims editing for evaluation and management (E&M) services on commercial plans. If billed E&M services don't support the level of service claimed, reimbursement will be automatically adjusted to a lower validated level based on AMA guidelines.
BCBS Texas · Effective Jun 8, 2026High impact
Reimbursement Policy Updates
Blue Cross Blue Shield of Texas updated 23 laboratory and diagnostic reimbursement policies effective between June 8, 2026 and September 4, 2026. These policies cover payment rules and methodologies for various laboratory tests including flow cytometry, biomarker testing, hormone testing, and cancer screening procedures.
BCBS Texas · Effective May 1, 2026High impact
See Updates to Our Fee Schedules
Blue Cross Blue Shield of Texas is implementing changes to maximum allowable professional and ancillary fee schedules effective May 1, 2026, affecting multiple networks including Blue Choice PPO, Blue Essentials, Blue Premier, Blue Advantage HMO, Blue High Performance Network, MyBlue Health, and ParPlan networks. This represents reimbursement rate changes that will impact payment amounts for services.
BCBS Texas · Effective Apr 1, 2026High impact
Prior Authorization Changes for Some Commercial and Government Program Members
Blue Cross Blue Shield of Texas is implementing multiple prior authorization changes affecting commercial, Medicaid, and Medicare Advantage members starting April 1, 2026. New prior authorization requirements will be added for various services including oncology, advanced imaging, sleep studies, and genetic testing, with different review organizations handling different service types.
BCBS Texas · Effective Apr 1, 2026High impact
Update: Paid Claims Editing To Be Enhanced in April 2026 for Medicaid and Medicare Advantage Members
Beginning April 2026, enhanced post-payment claims editing and review processes will be implemented for Medicaid and Medicare Advantage members to ensure proper reimbursement. Inaccurately coded claims will result in recovery requests if overpayments were made, requiring strict adherence to standard coding guidelines.
BCBS Texas · Effective Mar 1, 2026High impact
Remember to use Proper Coding for Evaluation and Management Services, Modifiers and Oncology Drugs and Services for Medicare and Medicaid Claims
Effective March 1, 2026, Blue Cross Blue Shield Texas will enhance claims editing and review processes to monitor proper use of Evaluation and Management coding, Oncology Drugs and Services coding, and Modifiers 25 and 59. Claims with inaccurate modifier usage may result in delayed or denied payment for Medicare Advantage and Medicaid claims.
BCBS Texas · Effective Mar 1, 2026High impact
Enhanced Diagnosis Claim Edits to Follow CMS Guidelines
Starting March 1, 2026, enhanced claims editing will verify ICD-10-CM diagnosis codes and deny claims with incompatible diagnosis pairs according to CMS guidelines. Providers must follow proper ICD-10-CM coding guidelines to avoid claim denials.
BCBS Texas · Effective Jan 30, 2026High impact
2026 Prior Authorization Exemption Renewal Results Now Available
Blue Cross and Blue Shield of Texas has completed its annual review of prior authorization exemptions and released renewal results. Providers whose exemptions did not meet the 90% medical necessity threshold will have their exemptions rescinded and must resume submitting prior authorization requests for those services.
BCBS Texas · Effective Jan 1, 2026High impact
FAQ Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
Effective January 1, 2026, Blue Cross and Blue Shield of Texas is transferring prior authorization review for five care categories (advanced imaging, musculoskeletal, sleep, medical specialty drugs, and genetic testing) from EviCore to BCBSTX for Medicare Advantage members. Providers must submit prior authorization requests for these services directly to BCBSTX instead of EviCore for dates of service on or after January 1, 2026.
BCBS Texas · Effective Jan 1, 2026High impact
Changes to Our Prior Authorization Programs for Medicare Advantage
Effective January 1, 2026, prior authorization requests for Medicare Advantage members in several care categories (Advanced Imaging, Musculoskeletal, Sleep, Medical Specialty Drugs, Genetic Testing) must now be submitted to BCBSTX instead of EviCore. The change reduces prior authorization requirements to fewer than 20% of codes and aims to streamline the process.
BCBS Texas · Effective Jan 1, 2026High impact
Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization
Blue Cross Blue Shield of Texas is implementing enhanced prior authorization for certain medical benefit drugs (including Infliximab, Pegfilgrastim, Rituximab, and Trastuzumab biosimilars) administered in clinical settings. When submitting prior authorization requests for non-preferred drugs, providers will receive a list of preferred therapeutic equivalents or alternatives that must be considered first.
BCBS Texas · Effective Jan 1, 2026High impact
Prior Authorization Changes for Some Commercial and Government Program Members, Effective Jan. 1, 2026
Blue Cross Blue Shield of Texas is adding new prior authorization requirements effective January 1, 2026. Commercial members will need prior auth for Advanced Imaging, Sleep studies, and Genetic Testing (reviewed by Carelon). Government program members (Medicare Advantage) will need prior auth for Specialty Drugs and Molecular Genetic Lab Testing (reviewed by EviCore).
BCBS Texas · Effective Jan 1, 2026High impact
Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2026 – Part 1
6, 2025. Blue Cross and Blue Shield of Texas changed its pharmacy drug lists effective Jan. 1, 2026, with some drugs excluded from coverage and others moved to a higher out-of-pocket payment level, and it added new prior authorization programs and dispensing limits. Humira and Stelara coverage changed on most commercial drug lists starting Jan. 1, 2026, and the CivicaScript versions of capecitabine (50 mg and 500 mg) and dalfampridine (10 mg) became the only generic versions covered for members on all Individual & Family Market and commercial-group drug lists, starting Jan. 1, 2026, or upon renewal.
BCBS Texas · Effective Jan 1, 2026High impact
Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
Effective January 1, 2026, Blue Cross Blue Shield of Texas is taking over prior authorization review for Medicare Advantage members in five care categories that were previously handled by EviCore healthcare. Billing teams must now submit prior authorization requests for advanced imaging, musculoskeletal services, sleep studies, medical specialty drugs, and genetic testing directly to BCBSTX instead of EviCore.
BCBS Texas · Effective Jan 1, 2026High impact
Prior Authorization Changes for Some Commercial and Government Program Members
Blue Cross Blue Shield of Texas is implementing major changes to prior authorization requirements and review vendors for commercial and Medicare Advantage members. Multiple service categories including advanced imaging, musculoskeletal procedures, oncology, genetic testing, and specialty drugs will have new prior auth requirements or transfer to different review entities (BCBSTX, Carelon, or removal from EviCore).
BCBS Texas · Effective Dec 1, 2025High impact
Clinical Payment and Coding Policy Updates
Blue Cross Blue Shield Texas updated 10 Clinical Payment and Coding Policies affecting various specialties, with effective dates ranging from December 1, 2025 to March 20, 2026. The updates cover facility unbundling, preventive services, psychological testing, behavioral analysis, drug testing, E&M coding, corrected claims, readmissions, and point-of-care ultrasound policies.
BCBS Texas · Effective Nov 16, 2025High impact
Five New Claims Editing Rules will be Implemented November 2025
Blue Cross Blue Shield of Texas will implement five new claims editing rules on November 16, 2025, affecting coding and reimbursement for emergency room surgical services, STI testing, radiation therapy, trauma activation, and professional/technical components. Claims receiving secondary edits will show ineligible reason codes with 'L' alpha character.
BCBS Texas · Effective Oct 31, 2025High impact
Clinical Payment and Coding Policy Updates
Blue Cross Blue Shield of Texas updated six clinical payment and coding policies affecting revenue code requirements, medical record documentation, neurophysiology monitoring, facet injections, rehabilitation services, and emergency department E/M coding. These changes have staggered effective dates from October 31 to November 21, 2025.
BCBS Texas · Effective Oct 1, 2025High impact
Prior Authorization Code Changes for Commercial Members, Effective Oct. 1, 2025
Blue Cross Blue Shield of Texas is updating prior authorization requirements for commercial members effective October 1, 2025. New codes are being added for sleep medicine, genetic testing, musculoskeletal, and medical oncology services that will require prior authorization through Carelon Medical Benefits Management, while some existing codes are being replaced or removed.
BCBS Texas · Effective Oct 1, 2025High impact
Prior Authorization Code Updates for Medicare Advantage, Effective Oct. 1, 2025
Blue Cross Blue Shield of Texas is updating prior authorization requirements for Medicare Advantage members effective October 1, 2025. Key changes include removing musculoskeletal codes from EviCore review, adding new specialty drug and lab codes to EviCore review, and transferring proton beam codes from BCBSTX to EviCore review.
BCBS Texas · Effective Aug 1, 2025High impact
Your NICU Claims Submissions Should Match Prior Authorization Levels of Care Effective Aug. 1, 2025
Starting August 1, 2025, BCBSTX will only pay for the exact level of NICU care that was authorized in prior authorization requests. If the billed level of care doesn't match the authorized level, payments will be reduced, though providers can request post-service medical necessity reviews for higher reimbursement.
BCBS Texas · Effective Jul 29, 2025High impact
Follow Guidelines for Making Physician Referrals for HMO Members
Blue Cross Blue Shield of Texas has updated referral procedures for HMO members enrolled in Blue Advantage HMO, Blue Advantage Plus HMO, Blue Essentials, and My Blue Health plans. Providers must now call the customer service number on the member ID card to request referrals, with processing times of 5 business days for standard requests and 24 hours for urgent requests.
BCBS Texas · Effective Jul 1, 2025High impact
Prior Authorization Code Changes for Commercial Members, Effective July 1, 2025
Blue Cross Blue Shield of Texas is updating prior authorization requirements for commercial members effective July 1, 2025. Changes include new codes for non-emergency air ambulance, genetic testing, and medical oncology requiring prior auth, plus updates to specialty drug codes.
BCBS Texas · Effective Jun 1, 2025High impact
Claims Review to Be Enhanced for Oncology Drugs and Services for Government Programs, Effective June 1, 2025
Effective June 1, 2025, enhanced claims review will be implemented for oncology drugs and associated services for Medicare Advantage and Medicaid members. Claims lacking appropriate procedure and diagnosis codes will face delays or denials, requiring strict adherence to standard coding guidelines including ICD-10, HCPCS, and CPT codes.
BCBS Texas · Effective Jun 1, 2025High impact
Alacura to Manage Medical Transportation for TRS Participants, Effective June 1, 2025
Effective June 1, 2025, Alacura will manage all air and ground medical transportation prior authorization, clinical review, and claim reviews for Teacher Retirement System (TRS) participants. Facilities and ambulance providers must contact Alacura immediately when transport decisions are made to ensure approval and coverage.
BCBS Texas · Effective Jun 1, 2025High impact
Update: Access BlueApprovRSM in Availity® Authorizations, Effective in June 2025
BlueApprovR utilization management tool will be integrated into Availity Authorizations in June 2025, requiring providers to change how they submit prior authorization requests. The tool will be disabled in Availity Payer Spaces and providers must use the new Authorizations & Referrals section in Availity instead.
BCBS Texas · Effective May 29, 2025High impact
Providers with Unused Record IDs May be Terminated from Networks
Blue Cross Blue Shield of Texas will terminate provider network participation for unused record IDs if no claims are filed within 24 months. Providers must actively file claims under each record ID to maintain network status.
BCBS Texas · Identified Sep 23, 2026High impact
Reimbursement Policy Updates
Blue Cross Blue Shield Texas has published updates to four reimbursement policies affecting anesthesia professional services, infusion services, non-reimbursable experimental/investigational services, and pathogen panel testing. These policy updates have staggered effective dates between September and December 2026. The actual policy content details are not included in this notice, requiring your team to access the full policy documents to identify specific billing code impacts and documentation requirements.
BCBS Texas · Identified Sep 1, 2026High impact
Prior Authorization Changes for Some Commercial and Government Program Members
Blue Cross Blue Shield of Texas is updating prior authorization (PA) requirements for Commercial, Medicare Advantage, and Medicaid members effective on three different dates between October 2026 and January 2027. Changes include removal of behavioral health and miscellaneous codes from PA requirements for Commercial members, addition of radiation oncology codes, replacement of oncology codes for Medicare, and addition of specific drug codes for Medicaid. Billing teams must verify eligibility and PA requirements through Availity before service delivery, as claims without required PA will be denied and providers cannot bill members.
BCBS Texas · Identified May 3, 2026High impact
Providers with Unused Record IDs May Be Terminated from Networks
Blue Cross Blue Shield of Texas will terminate providers from networks if they don't file claims using their NPI and TIN within 24 months. Providers must actively bill to keep their record IDs active, or risk network termination and need to reapply through the onboarding process.
BCBS Texas · Identified Jan 12, 2026High impact
Update: Your NICU Claims Submissions Should Match Prior Authorization Levels of Care
Blue Cross Blue Shield of Texas requires NICU claims submissions to match the exact level of care specified in prior authorizations for commercial members. Claims that don't match the authorized level of care will result in reduced payments, though providers can submit reconsiderations for post-service medical necessity review.
BCBS Texas · Identified Jan 12, 2026High impact
Keep Your Record ID Active To Prevent Network Termination
Blue Cross and Blue Shield of Texas will cancel provider record IDs if no claims are filed using the associated billing or rendering NPI and TIN within 24 months, potentially terminating network participation. Providers must file claims regularly to keep their record IDs active, or complete a provider onboarding form to reinstate canceled IDs.

Payer news

Network, contract and program news from the payers we track.

BCBS Texas · Aug 28, 2026Payer news
PEAQSM Provider Performance Insights Reports Are Now Available
Blue Cross and Blue Shield of Texas (BCBSTX) has launched Provider Performance Insights (PEAQ) reports for eligible Texas providers, measuring efficiency, appropriateness, and quality.
BCBS Texas · Jun 9, 2026Payer news
Esperta Health Offers Members Specialty In-Home Wound Care Services
Blue Cross Blue Shield of Texas is partnering with Esperta Health to provide in-home wound care services at no additional charge to commercial members with chronic wounds.
BCBS Texas · Feb 23, 2026Payer news
New Data on Quality Measures for Reporting Year 2024
Blue Cross Blue Shield Texas released 2024 quality measure performance data showing improvements across HEDIS measures like blood pressure control, cancer screenings, and diabetes management for commercial HMO, PPO, and marketplace plans.
BCBS Texas · Feb 18, 2026Payer news
GeoBlue® Is Now Blue Cross Blue Shield Global Solutions℠
GeoBlue has been rebranded to Blue Cross Blue Shield Global Solutions, with transition completing by end of 2027.
BCBS Texas · Aug 27, 2025Payer news
Watch for Updated Out-of-area Member ID Cards with No Suitcase Logo
Blue Cross Blue Shield Plans are updating member ID cards to remove the suitcase logo for out-of-area members. The benefit plan type will still be displayed on cards, and out-of-area benefits remain unchanged.
BCBS Texas · Aug 18, 2025Payer news
PEAQSM Physician Performance Insight Reports Are Now Available
Blue Cross Blue Shield of Texas has launched PEAQ Physician Performance Insight reports that rate physicians against peers and will influence Provider Finder search results and physician profiles.

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New Claims Editing Rules To Be Implemented in December 2026

Prior Authorization Changes for Some Government Program Members

Spinal Fusion Surgery Prior Authorization Requirements Changing for TRS Participants

New Digital Interfaces To Simplify Prior Authorization Requests

Watch for New Edge Benefit Plan Members in 2027

We’ll Begin Removing Recommended Clinical Review as an Optional Medical Necessity Review, Effective Jan. 1, 2027

Changes Coming to the Medical Drug Benefit Program

Updates to Behavioral Health Substance Abuse Criteria for Utilization Management

Enhanced Review of Laboratory, Genetic and Molecular Testing Claims

We’ll Conduct coordination of Benefit Reviews for Medicaid Claims to Identify Potential Overlaps in Coverage

Reminder: We’ll Conduct Postpayment Reviews on Medicaid Claims

Prior Authorization Changes for Some Commercial and Government Program Members

Prior Authorization Changes for Some Members

Learn About Enhancements to Medicaid Utilization Management Process, Effective Sept. 18, 2026

TRS Participants Have Updated Plans

Prior Authorization Changes for Some Commercial and Government Program Members

New Claims Editing Rules To Be Implemented in July 2026

Register for Webinar on Coding for Evaluation and Management Claims

Claim Editing Changes for Evaluation and Management Services for Commercial Members, Effective July 1, 2026

Reimbursement Policy Updates

See Updates to Our Fee Schedules

Prior Authorization Changes for Some Commercial and Government Program Members

Update: Paid Claims Editing To Be Enhanced in April 2026 for Medicaid and Medicare Advantage Members

Remember to use Proper Coding for Evaluation and Management Services, Modifiers and Oncology Drugs and Services for Medicare and Medicaid Claims

Enhanced Diagnosis Claim Edits to Follow CMS Guidelines

2026 Prior Authorization Exemption Renewal Results Now Available

FAQ Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026

Changes to Our Prior Authorization Programs for Medicare Advantage

Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization

Prior Authorization Changes for Some Commercial and Government Program Members, Effective Jan. 1, 2026

Pharmacy Program Quarterly Update Changes Effective Jan. 1, 2026 – Part 1

Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026

Prior Authorization Changes for Some Commercial and Government Program Members

Clinical Payment and Coding Policy Updates

Five New Claims Editing Rules will be Implemented November 2025

Clinical Payment and Coding Policy Updates

Prior Authorization Code Changes for Commercial Members, Effective Oct. 1, 2025

Prior Authorization Code Updates for Medicare Advantage, Effective Oct. 1, 2025

Your NICU Claims Submissions Should Match Prior Authorization Levels of Care Effective Aug. 1, 2025

Follow Guidelines for Making Physician Referrals for HMO Members

Prior Authorization Code Changes for Commercial Members, Effective July 1, 2025

Claims Review to Be Enhanced for Oncology Drugs and Services for Government Programs, Effective June 1, 2025

Alacura to Manage Medical Transportation for TRS Participants, Effective June 1, 2025

Update: Access BlueApprovRSM in Availity® Authorizations, Effective in June 2025

Providers with Unused Record IDs May be Terminated from Networks

Reimbursement Policy Updates

Prior Authorization Changes for Some Commercial and Government Program Members

Providers with Unused Record IDs May Be Terminated from Networks

Update: Your NICU Claims Submissions Should Match Prior Authorization Levels of Care

Keep Your Record ID Active To Prevent Network Termination

Payer news

PEAQSM Provider Performance Insights Reports Are Now Available ↗

Esperta Health Offers Members Specialty In-Home Wound Care Services ↗

New Data on Quality Measures for Reporting Year 2024 ↗

GeoBlue® Is Now Blue Cross Blue Shield Global Solutions℠ ↗

Watch for Updated Out-of-area Member ID Cards with No Suitcase Logo ↗

PEAQSM Physician Performance Insight Reports Are Now Available ↗

PEAQSM Provider Performance Insights Reports Are Now Available

Esperta Health Offers Members Specialty In-Home Wound Care Services

New Data on Quality Measures for Reporting Year 2024

GeoBlue® Is Now Blue Cross Blue Shield Global Solutions℠

Watch for Updated Out-of-area Member ID Cards with No Suitcase Logo

PEAQSM Physician Performance Insight Reports Are Now Available