Medicare AdvantagePrior AuthMedium impact
MAPAP300 - True Blue HMO 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
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated their True Blue HMO Medicare Advantage prior authorization policy, revising Part B drug requirements, self-administered drug exclusions, and phone authorization procedures. The policy adds reference to MA PAP229 for retrospective authorization guidelines and clarifies that self-administered drugs are non-covered under Part B medical benefits.
Action Required
Immediately: Billing team must verify prior authorization requirements for Part B drugs using the updated Prior Authorization Procedure Code Lookup tool before submitting claims. Stop billing self-administered drugs under Part B medical benefit - redirect these to Part D prescription drug benefit instead. Update workflow to reference MA PAP229 for any retrospective authorization scenarios involving compelling circumstances.