CommercialPrior AuthHigh impact
We’ll Begin Removing Recommended Clinical Review as an Optional Medical Necessity Review, Effective Jan. 1, 2027
BCBS Oklahoma·OK·Medical Policy
Effective date
Jan 1, 2027
We identified it
Sep 17, 2026
Summary
Effective January 1, 2027, Blue Cross Blue Shield of Oklahoma will begin phasing out 'recommended clinical review' as an optional medical necessity review option for commercial members, with complete removal expected by end of 2027. Services that previously qualified for recommended clinical review may now require prior authorization instead. Medicare and Medicaid members are unaffected as they never had this option.
Action Required
By December 31, 2026: Billing team must audit current workflows to identify all services currently submitted as 'recommended clinical review' requests. By January 1, 2027: Update billing system configuration to eliminate 'recommended clinical review' as a submission option for commercial claims; redirect affected service requests to prior authorization pathway instead. Update encounter forms and provider documentation templates to reflect that prior authorization (rather than recommended review) is now required for applicable services. Implement staff training to ensure all clinical and billing personnel understand that checking eligibility and benefits through Availity Essentials or preferred vendor is now mandatory to determine prior authorization requirements before service delivery. Throughout 2027: Monitor claim denials related to missing prior authorizations and adjust workflows as needed. Failure to obtain required prior authorization will result in claim denials.