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BCBS IllinoisMedicare Advantage · Prior Auth · Prior Authorization · IL · Oncology, Radiology, Orthopedics +3 moreHigh impact

Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jun 16, 2026

Summary

Effective January 1, 2026, Blue Cross Blue Shield of Illinois is taking over prior authorization reviews for Medicare Advantage members from EviCore healthcare for five care categories: advanced imaging, musculoskeletal services, sleep medicine, medical specialty drugs, and genetic testing. All prior authorization requests for these categories must now be submitted directly to BCBSIL instead of EviCore.

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What to do

by Jan 1, 2026 · 4 steps
01Billing team must update prior authorization submission workflows to send requests for advanced imaging, musculoskeletal services, sleep medicine, medical specialty drugs, and genetic testing directly to BCBSIL instead of EviCore for Medicare Advantage members.
02Update staff training and reference materials.
03Continue checking eligibility through Availity Essentials to confirm prior auth requirements and proper submission channels.
04Monitor BCBSIL's prior authorization web page for updated submission processes.

Original notice

Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
bcbsil.com · Always check the source before changing claims.
View original ↗

Related changes

See all BCBS Illinois changes →
Prior Authorization Changes for Some Commercial and Government Program MembersHighEffective Oct 1, 2026 · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighNo effective date · Prior AuthorizationChanges to Our Prior Authorization Programs for Medicare AdvantageHighEffective Jan 1, 2026 · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighEffective Apr 1, 2026 · Prior AuthorizationBrowse every BCBS Illinois change in the policy list

Related policy hubs

BCBS Illinois policiesIL policy changesOncologyRadiologyOrthopedicsPM&R (Physical Medicine & Rehab)Sleep MedicineEndocrinology

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