Prior Authorization Changes for Some Commercial and Government Program Members

By October 1, 2026: Billing team must verify current prior authorization code lists through the BCBSOK provider portal for medical oncology drug codes now requiring review by Carelon. By January 1, 2027: Update billing system to route genetic testing codes to Carelon (addition) and remove previously reviewed genetic testing codes; transfer miscellaneous codes from recommended clinical review status to prior authorization requiring BCBSOK review; add medical oncology therapy codes and provider-administered drug codes to Carelon review. For Medicare Advantage members: Add oncology drug, orthotics, wound care, and DME codes to BCBSOK review queue. Update all encounter forms and billing workflows to eliminate 'Recommended Clinical Review' option and require prior authorization instead. Billing staff must confirm eligibility and prior authorization requirements in Availity Essentials or preferred vendor BEFORE rendering services. Train all staff that services performed without required prior authorization will result in claim denials with no member balance billing allowed. Review detailed code lists at https://www.bcbsok.com/provider/education/education-reference/news-updates/2026/9-30-2026-prior-authorization-changes.