Medicare AdvantagePrior AuthMedium impact
We’ve Reviewed Prior Authorization Exemptions for May 1, 2025, Through April 30, 2026
BCBS Texas·TX·Prior Authorization
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Blue Cross Blue Shield of Texas has completed its annual review of prior authorization exemptions effective May 1, 2025 through April 30, 2026, with results now available as of July 1, 2026. Providers who qualified for exemptions must submit notifications through Availity Essentials to determine initial length of stay or units exempted, and must understand that services beyond initial exemption limits remain subject to medical necessity review and concurrent review requirements.
Action Required
By July 1, 2026: Billing and clinical staff must access the Provider Correspondence Viewer in Availity Essentials to identify which providers have received new or rescinded prior authorization exemptions. For any provider who qualified for an exemption: (1) Submit notification to BCBSTX through Availity Essentials or by calling the member's ID card number to receive written acknowledgement of initial length of stay or units exempted; (2) Update billing workflows to recognize exemptions for initial services only; (3) Ensure concurrent review is still performed for services extending beyond initial exemption limits or care guidelines. For exemptions that were denied after qualification review, document the 30-day appeal deadline (fax 972-907-1868 or email) to the independent review organization. Pharmacy exemptions managed by PBM require direct communication with the pharmacy benefit manager, not BCBSTX. Failure to obtain proper notifications and acknowledgements may result in claim denials for services beyond the exempted scope.