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Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
Act
immediately
Effective date
Jan 1, 2026
Identified
Jan 12, 2026
Summary
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.
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What to do
immediately · 3 steps
01Update prior authorization submission workflows to send requests for Medicare Advantage members to BCBSTX instead of EviCore for these five categories: advanced imaging, musculoskeletal services, sleep studies, medical specialty drugs, and genetic testing.
02Train billing staff on the new submission process and update internal procedures.
03Continue checking eligibility and benefits through Availity Essentials to confirm prior auth requirements and proper submission vendor for each request.
Original notice
Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
bcbstx.com · Always check the source before changing claims.
Related changes
See all BCBS Texas changes →Prior Authorization Changes for Some Commercial and Government Program MembersHighEffective Oct 1, 2026 · Prior AuthorizationFAQ Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026HighEffective Jan 1, 2026 · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighEffective Aug 1, 2026 · Prior AuthorizationChanges to Our Prior Authorization Programs for Medicare AdvantageHighEffective Jan 1, 2026 · Prior AuthorizationBrowse every BCBS Texas change in the policy list