Prior Authorization Changes for Some Government Program Members, Effective Jan. 1, 2026
AI Summary
Effective January 1, 2026, Blue Cross Blue Shield of Texas is removing prior authorization requirements for certain laboratory codes that were previously reviewed by Evicore for Medicare Advantage members. This simplifies the prior authorization process by eliminating PA requirements for specific lab services.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows to remove PA requirements for lab codes previously requiring Evicore review for Medicare Advantage members. Check the current prior authorization lists in utilization management section to identify which specific lab codes are affected. Continue to verify eligibility and benefits through Availity Essentials before rendering services to confirm current PA requirements.
Plan Types
Medicare Advantage
States
TX
Specialties
laboratory, all-specialties