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Changes to Our Prior Authorization Programs for Medicare Advantage
Act
immediately
Effective date
Jan 1, 2026
Identified
May 3, 2026
Summary
Effective January 1, 2026, prior authorization requests for Medicare Advantage members in several care categories (Advanced Imaging, Musculoskeletal, Sleep, Medical Specialty Drugs, Genetic Testing) must now be submitted to BCBSTX instead of EviCore. The change reduces prior authorization requirements to fewer than 20% of codes and aims to streamline the process.
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What to do
immediately · 4 steps
01Billing team must redirect all prior authorization requests for Medicare Advantage members in Advanced Imaging, Musculoskeletal, Sleep, Medical Specialty Drugs, and Genetic Testing categories from EviCore to BCBSTX.
02Update workflow procedures to call the number on member ID cards or check Availity Essentials to verify authorization requirements.
03Review updated prior authorization code lists on BCBSTX website.
04Note: Continue submitting Proton Beam Therapy requests to EviCore.
Original notice
Changes to Our Prior Authorization Programs for Medicare Advantage
bcbstx.com · Always check the source before changing claims.
Related changes
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