CommercialPrior AuthHigh impact
Prior Authorization Changes for Some Commercial and Government Program Members
BCBS Montana·MT · Diagnostic Imaging, Oncology, Orthopedics·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 18, 2026
Summary
Blue Cross Blue Shield of Montana is implementing prior authorization changes across multiple plan types with different effective dates. Key changes include adding medical transportation and advanced imaging codes for commercial members, miscellaneous codes for Medicare Advantage, and several code additions/removals for Healthy Montana Kids members.
Action Required
By April 1, 2026: Billing team must update prior authorization workflows for commercial and Medicare Advantage members. For commercial members, verify prior auth requirements for new medical transportation codes (reviewed by Alacura) and advanced imaging codes (reviewed by Carelon). For Medicare Advantage members, check prior auth for new miscellaneous codes (reviewed by BCBSMT). Always verify eligibility and benefits through Availity Essentials before rendering services. For HMK members, note that changes already took effect January 1, 2026. Failure to obtain required prior authorization may result in claim denials.