CommercialPrior AuthHigh impact
BCBSMA New Utilization Management Program
Blue Cross Blue Shield of Kansas·MA·Provider News
Effective date
Jan 1, 2022
We identified it
Jun 19, 2026
Summary
BCBS Massachusetts is expanding its utilization management program to require prior authorization for certain services for Commercial EPO and PPO members, aligning them with existing HMO and POS requirements. The same authorization requirements are also being implemented for Medicare Advantage members.
Action Required
By January 1, 2022: Billing team must verify prior authorization requirements for all BCBSMA Commercial EPO, PPO, and Medicare Advantage members before scheduling services. Call 1-800-676-BLUE or the number on member's card for authorization. Update workflow to check Medical Policy Router and General Pre-Requirements. Claims will be denied without proper prior authorization.