CommercialPrior AuthHigh impact
Prior Authorization Changes for Some Commercial Government Program Members
BCBS Oklahoma·OK · Radiology, Oncology, Genetics·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Jun 30, 2026
Summary
Blue Cross Blue Shield of Oklahoma is implementing prior authorization requirement changes for commercial and Medicare Advantage members, effective on staggered dates. Commercial members will see changes to radiology advanced imaging, molecular genetic lab testing, and medical oncology codes reviewed by Carelon, plus drug codes reviewed by BCBSOK starting October 1, 2026. Medicare Advantage members will experience Part B Step Therapy Program changes and miscellaneous code reviews starting August 1 and October 1, 2026.
Action Required
By August 1, 2026: Medicare Advantage billing team must update prior authorization requirements for Part B Step Therapy Program and miscellaneous codes now reviewed by BCBSOK or EviCore Healthcare per the revised prior authorization lists available through BCBSOK. By October 1, 2026: Commercial billing team must update prior authorization requirements for radiology advanced imaging codes, molecular genetic lab testing codes, medical oncology codes, and drug codes per revised lists reviewed by Carelon Medical Benefits Management or BCBSOK. All billing staff must check eligibility and benefits through Availity Essentials or preferred vendor before rendering services to confirm current prior authorization requirements and utilization management vendors. Update billing system rules, encounter forms, and pre-service verification workflows to reflect these changes. Obtain revised prior authorization code lists from BCBSOK website. Train providers and staff on new requirements. Services performed without required prior authorization will be denied and providers may not bill members for non-covered services. Failure to update workflows before effective dates will result in claim denials.