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BCBS MontanaCommercial · Prior Auth · Prior Authorization · MT · Oncology, Radiology, OrthopedicsHigh impact

Prior Authorization Changes for Some Commercial and Government Program Members

Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jun 18, 2026

Summary

Blue Cross Blue Shield of Montana is implementing prior authorization changes across multiple plan types with different effective dates. Key changes include adding medical transportation and advanced imaging codes for commercial members, miscellaneous codes for Medicare Advantage, and several code additions/removals for Healthy Montana Kids members.

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What to do

by Apr 1, 2026 · 5 steps
01Billing team must update prior authorization workflows for commercial and Medicare Advantage members.
02For commercial members, verify prior auth requirements for new medical transportation codes (reviewed by Alacura) and advanced imaging codes (reviewed by Carelon).
03For Medicare Advantage members, check prior auth for new miscellaneous codes (reviewed by BCBSMT).
04Always verify eligibility and benefits through Availity Essentials before rendering services.
05For HMK members, note that changes already took effect January 1, 2026.
If missed: Failure to obtain required prior authorization may result in claim denials.

Original notice

Prior Authorization Changes for Some Commercial and Government Program Members
bcbsmt.com · Always check the source before changing claims.
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Related changes

See all BCBS Montana changes →
Prior Authorization Changes for Some Commercial and Government Program MembersHighEffective Jan 1, 2027 · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighNo effective date · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program MembersHighEffective Aug 1, 2026 · Prior AuthorizationPrior Authorization Changes for Some Commercial and Government Program Members, Effective April 1, 2026MediumEffective Apr 1, 2026 · Prior AuthorizationBrowse every BCBS Montana change in the policy list

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BCBS Montana policiesMT policy changesOncologyRadiologyOrthopedics

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