Medicare AdvantagePrior AuthMedium impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Texas·TX·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 13, 2026
Summary
BCBS Texas is implementing multiple prior authorization changes across different timeframes: Medicare Advantage and Medicaid changes begin April 1, 2026, with additional Medicaid and commercial changes starting July 1, 2026. The changes involve adding or removing miscellaneous codes and advanced imaging requirements, with different utilization management vendors handling reviews for each plan type.
Action Required
By March 31, 2026: Billing team must update prior authorization workflows for BCBS Texas members. Review utilization management prior authorization lists to identify specific codes affected. Update billing system to flag new prior auth requirements for Medicare Advantage members (reviewed by BCBSTX/EviCore) and commercial members (reviewed by Carelon/Alacura). Always verify eligibility and benefits through Availity Essentials before rendering services. Train staff that services performed without required prior authorization may be denied and providers cannot bill patients.