Medicare AdvantagePrior AuthHigh impact
Update: Prior Authorization Changes for Medicare Advantage Members, Effective Jan. 1, 2026
BCBS Oklahoma·OK · Radiology, Orthopedics, Sleep Medicine·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Effective January 1, 2026, prior authorization requests for Medicare Advantage members must now be submitted directly to BCBSOK instead of EviCore healthcare for five specific care categories: advanced imaging, musculoskeletal services, sleep medicine, medical specialty drugs, and genetic testing. This represents a significant workflow change requiring immediate updates to authorization submission processes.
Action Required
Immediately: Update prior authorization workflows to submit requests for Medicare Advantage members directly to BCBSOK (not EviCore) for advanced imaging, musculoskeletal services, sleep medicine, medical specialty drugs, and genetic testing. Train billing staff on new submission process and update internal procedures. Continue checking eligibility through Availity Essentials to confirm prior auth requirements and proper vendor routing. Monitor BCBSOK's prior authorization page for updated forms and procedures.