Medicare AdvantagePrior AuthHigh impact
Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
BCBS Montana·MT · Orthopedics, Sleep Medicine·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Effective January 1, 2026, Blue Cross Blue Shield of Montana is transferring prior authorization review responsibilities from EviCore healthcare back to BCBSMT for Medicare Advantage members in four specific care categories. All prior authorization requests for advanced musculoskeletal services, sleep medicine, specialty drugs, and genetic testing must now be submitted directly to BCBSMT instead of EviCore.
Action Required
By January 1, 2026: Billing team must update prior authorization submission process for Medicare Advantage members to submit requests directly to BCBSMT (not EviCore) for advanced musculoskeletal services, sleep medicine, specialty drugs, and genetic testing. Update staff workflows and contact information in billing system. Continue checking eligibility through Availity Essentials to confirm prior auth requirements and proper submission vendor.