CommercialPrior AuthMedium impact
Review of Rescinded Prior Authorization Exemptions for Jan. 1 Through June 30, 2025
BCBS Texas·TX·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Jan 12, 2026
Summary
BCBS Texas has reviewed and reinstated prior authorization exemptions for providers who maintained at least 90% approval rates during Jan-June 2025. Providers who qualified for exemption reinstatement effective July 1, 2025 must submit notifications to determine initial length of stay or units covered by their exemptions.
Action Required
By July 1, 2025: Providers with reinstated prior authorization exemptions must check results in Availity Essentials Provider Correspondence Viewer. Submit notifications through Availity or call member ID card number to determine initial length of stay or units covered by exemptions. Services beyond initial exempted amounts may still require medical necessity review.