CommercialPrior AuthMedium impact
PAP241 - Prior Authorization Requirements - Removed all reference to preservice provider appeal and changed language to allow for one reconsideration.
Blue Cross of Idaho·ID·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho removed preservice provider appeal language from their prior authorization policy and now limits providers to only one reconsideration request for PA denials. This significantly restricts appeal options for denied prior authorization requests.
Action Required
By April 1, 2026: Review all pending prior authorization appeals with Blue Cross of Idaho to ensure they comply with the new single reconsideration limit. Update staff training to emphasize the importance of submitting complete clinical documentation with initial PA requests, as appeal options are now more limited. Billing team should track reconsideration requests to ensure only one is submitted per denial.