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Out-of-Network Providers Must Obtain Prior Authorization for Most Services Rendered to Medicaid Members
Act
by Feb 25, 2026
Effective date
Feb 25, 2026
Identified
Jun 16, 2026
Summary
Out-of-network providers must now obtain prior authorization for most services rendered to Blue Cross Community Health Plans Medicaid members. Services without required prior authorization may be denied and providers cannot seek reimbursement from members.
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What to do
by Feb 25, 2026 · 3 steps
01Billing team must update workflow to verify eligibility and check prior authorization requirements through Availity Essentials before rendering services to any Blue Cross Community Health Plans Medicaid members.
02Train staff to identify out-of-network status and obtain prior authorization for all services except emergency care, family planning, and EPSDT screening services for children.
03Claims without prior auth will be denied and members cannot be billed.
Original notice
Out-of-Network Providers Must Obtain Prior Authorization for Most Services Rendered to Medicaid Members
bcbsil.com · Always check the source before changing claims.