Medicare AdvantagePrior AuthHigh impact
Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
BCBS Illinois·IL · Radiology, Diagnostic Imaging, Orthopedics +4 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
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.
Action Required
By January 1, 2026: Billing 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. Update staff training and reference materials. Continue checking eligibility through Availity Essentials to confirm prior auth requirements and proper submission channels. Monitor BCBSIL's prior authorization web page for updated submission processes.