Medicare AdvantagePrior AuthHigh impact
One-to-One for Healthcare - Winter Edition
Blue Cross of Idaho·ID·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho is implementing significant changes to Medicare Advantage plans effective January 1, 2026, requiring all members to choose a PCP and obtain referrals for specialty care, ancillary services, and out-of-network visits. A 90-day grace period (January 1 - April 1) will allow providers time to establish referral processes.
Action Required
By January 1, 2026: All staff must establish user accounts on providers.bcidaho.com provider portal to submit referrals for Medicare Advantage members. Front desk staff must verify PCP assignments for all MA members and obtain referrals from PCPs before scheduling specialty visits. Billing team must update workflows to check referral status before submitting claims. Referrals must be submitted prior to specialist visits and are valid for up to 365 days. Review MAPAP310 for services exempt from referral requirements.