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BCBS OklahomaMedicare Advantage · Prior Auth · Prior Authorization · OK · Orthopedics, General Surgery, Ophthalmology +6 moreHigh impact

Prior Authorization Changes for Some Government Program Members

Act
by Dec 21, 2026
Effective date
Dec 21, 2026
Identified
Oct 31, 2026

Summary

Blue Cross and Blue Shield of Oklahoma is removing prior authorization requirements for specific service categories (proprietary laboratory analyses, drugs/biologics, molecular pathology/genetics, infectious disease molecular testing, radiology, advanced imaging, orthopedic surgery, foot and ankle surgery, plastic/reconstructive surgery, vascular surgery, organ transplant, general surgery, ophthalmology, and miscellaneous specialty procedures) for Medicare Advantage members effective December 21, 2026. Additionally, the plan will begin phasing out Recommended Clinical Review options starting January 1, 2027, with complete removal expected by end of 2027 for most commercial members.

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What to do

by Dec 21, 2026 · 6 steps
01Billing and authorization team must update prior authorization workflows to remove requirements for the listed service categories for Medicare Advantage members.
02Confirm removal of prior auth requirements in billing system and authorization protocols for: proprietary laboratory analyses, drugs/biologics, molecular pathology/genetics, infectious disease molecular testing, radiology, advanced imaging, orthopedic surgery, foot and ankle surgery, plastic/reconstructive surgery, vascular surgery, organ transplant, general surgery, and ophthalmology procedures.
03Refer to the revised prior authorization lists on the BCBSOK provider portal for complete code-specific guidance.
04Starting January 1, 2027: Billing team should prepare for phased removal of Recommended Clinical Review option from utilization management processes; anticipate complete removal for most commercial members by end of 2027.
05Front desk and authorization staff must continue verifying eligibility and benefits through Availity Essentials or preferred vendors before service delivery, as this does not guarantee payment.
06Note: Claims submitted without required prior authorization (where still applicable) or that do not meet medical necessity criteria may be denied and providers cannot seek reimbursement from members.

Original notice

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

See all BCBS Oklahoma changes →
Prior Authorization Changes for Some Government Program MembersMediumEffective Oct 1, 2026 · Prior AuthorizationBrowse every BCBS Oklahoma change in the policy list

Related policy hubs

BCBS Oklahoma policiesOK policy changesOrthopedicsGeneral SurgeryOphthalmologyPlastic SurgeryVascular SurgeryTransplant SurgeryRadiologyPathologyPodiatry

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