Medicare AdvantagePrior AuthMedium impact
Prior Authorization Changes for Some Government Program Members
BCBS Illinois·IL · Cardiology·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
BCBSIL is making multiple changes to prior authorization requirements for Medicare Advantage members, with some cardiology and lab codes being removed from prior auth requirements on July 1, 2026, and new miscellaneous codes being added to prior auth requirements on August 1, 2026.
Action Required
By June 30, 2026: Billing team must update prior authorization workflows for Medicare Advantage members - remove prior auth requirements for cardiology and lab codes effective July 1, and prepare to add prior auth requirements for new miscellaneous codes effective August 1. Check BCBSIL utilization management page for specific code lists. Update staff to verify eligibility and benefits through Availity before rendering services to confirm current prior auth requirements.