Medicare AdvantagePrior AuthHigh impact
Changes to Our Prior Authorization Programs for Medicare Advantage
BCBS Illinois·IL · Orthopedics, Radiology, Diagnostic Imaging +2 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 16, 2026
Summary
Effective January 1, 2026, prior authorization requests for Medicare Advantage members must now be submitted to BCBSIL instead of EviCore for Advanced Imaging, Musculoskeletal, Sleep Medical, Specialty Drugs, and Genetic Testing services. The change streamlines the process and reduces prior authorization requirements to fewer than 20% of codes.
Action Required
Immediately: Update billing workflows to submit prior authorization requests for Medicare Advantage members to BCBSIL instead of EviCore for Advanced Imaging, Musculoskeletal, Sleep Medical, Specialty Drugs, and Genetic Testing. Train staff to verify authorization requirements through Availity Essentials or member ID cards. Note: Proton Beam Therapy Services continue with EviCore. Review updated prior authorization code lists on BCBSIL website as fewer codes now require authorization.