Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
BCBS MontanaMedicare Advantage · Prior Auth · Prior Authorization · MT · Orthopedics, Sleep MedicineHigh impact

Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
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.

Get alerts when payers change rules like this one

We check BCBS Montana and other payers every day and email you when a change matches your specialty and state.

Get BCBS Montana alertsPolicy Monitoring is free. No card required.

What to do

by Jan 1, 2026 · 3 steps
01Billing 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.
02Update staff workflows and contact information in billing system.
03Continue checking eligibility through Availity Essentials to confirm prior auth requirements and proper submission vendor.

Original notice

Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
bcbsmt.com · Always check the source before changing claims.
View original ↗

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 MembersHighEffective Aug 1, 2026 · Prior AuthorizationChanges to Our Prior Authorization Programs for Medicare AdvantageHighEffective Jan 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

Related policy hubs

BCBS Montana policiesMT policy changesOrthopedicsSleep Medicine

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account