Medicare AdvantagePrior AuthHigh impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Montana·MT · Radiology, Genetics, Oncology +1 more·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Jun 30, 2026
Summary
Blue Cross and Blue Shield of Montana is updating prior authorization requirements for commercial, Medicare Advantage, and Medicaid members, effective on staggered dates between August and October 2026. Changes include additions and removals of radiology, molecular genetic testing, medical oncology, and miscellaneous codes under different utilization management vendors (Carelon, BCBSMT, EviCore), and implementation of a Part B Step Therapy Program for Medicare Advantage members.
Action Required
By July 15, 2026: Billing team must obtain and review the revised prior authorization code list from BCBSMT to identify all affected codes. Beginning August 1, 2026: For Medicare Advantage members, implement Part B Step Therapy Program requirements and update billing system to reflect removal and addition of miscellaneous codes reviewed by BCBSMT and EviCore. By September 15, 2026: For commercial members, configure billing software to route radiology advanced imaging, molecular genetic lab testing, and medical oncology codes to Carelon for prior authorization, and drug codes to BCBSMT for review, effective October 1, 2026. Update encounter forms and provider instructions to reflect new prior authorization workflows. Train billing and front desk staff on new requirements and routing rules. Failure to obtain required prior authorization will result in claim denials. Coordinate with Carelon, BCBSMT, EviCore, and Alacura to ensure proper code routing and system integration.