CommercialPrior AuthMedium impact
We’re Reviewing Existing Prior Authorization Exemptions
BCBS Texas·TX·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jan 12, 2026
Summary
Blue Cross Blue Shield of Texas is reviewing existing prior authorization exemptions that have been in effect for at least one year. They will randomly select at least 5 claims to verify that 90% or more were medically necessary - if less than 90% meet this threshold, the exemption will be rescinded.
Action Required
Immediately: Respond promptly to any requests for medical records from BCBS Texas for prior authorization exemption reviews. Check Availity Essentials Payer Spaces Provider Correspondence Viewer starting Jan 30, 2026 for review results. Ensure documentation supports medical necessity for services with current prior auth exemptions to maintain exemption status.