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Changes to Our Prior Authorization Programs for Medicare Advantage
Act
immediately
Effective date
Jan 1, 2026
Identified
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.
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What to do
immediately · 4 steps
01Update 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.
02Train staff to verify authorization requirements through Availity Essentials or member ID cards.
03Note: Proton Beam Therapy Services continue with EviCore.
04Review updated prior authorization code lists on BCBSIL website as fewer codes now require authorization.
Original notice
Changes to Our Prior Authorization Programs for Medicare Advantage
bcbsil.com · Always check the source before changing claims.