Medicare AdvantagePrior AuthMedium impact
Prior Authorization Changes for Some Government Program Members
BCBS Illinois·IL · Cardiology, Oncology, Radiology·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
Blue Cross is changing prior authorization requirements for Medicare Advantage and Blue Cross Community Health Plans members. Select proton beam codes will require prior authorization through BCBSIL starting October 1, 2026, while some cardiology and lab codes will have prior authorization removed starting July 1, 2026.
Action Required
By July 1, 2026: Billing team must update prior authorization workflows to remove requirements for cardiology codes and lab/miscellaneous codes previously reviewed by EviCore and BCBSIL. By August 1, 2026: Add prior authorization requirements for new miscellaneous codes reviewed by BCBSIL. By October 1, 2026: Update system to require prior authorization for select proton beam codes through BCBSIL. Always verify eligibility and benefits through Availity Essentials before rendering services to confirm current prior authorization requirements.