Medicare AdvantagePrior AuthHigh impact
MAPAP301 - Secure Blue PPO Prior Authorization - Updated Part B, self-administered drugs, Part B phone, and modifier for claims. Added reference to MA PAP229.
Blue Cross of Idaho·ID·Prior Authorization
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their Medicare Advantage prior authorization policy (MAPAP301) with changes to Part B self-administered drugs, Part B phone procedures, and claim modifiers. The policy adds a reference to MA PAP229 for compelling circumstances when prior authorization wasn't obtained.
Action Required
Immediately: Review updated Part B self-administered drug list at the SAD Drugs link to identify medications no longer covered under Part B for Medicare Advantage patients. Update billing system to flag these medications for Part D coverage instead. Verify Part B phone procedure requirements and any new modifier usage. Reference MA PAP229 for guidance on compelling circumstances when submitting provider disputes for claims denied due to missing prior authorization.