Medicare AdvantagePrior AuthHigh impact
Changes to Our Prior Authorization Programs for Medicare Advantage
BCBS Montana·MT · Radiology, Orthopedics, Sleep Medicine +1 more·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Effective January 1, 2026, Blue Cross Blue Shield of Montana is taking over prior authorization management from EviCore for Medicare Advantage members in several care categories including Advanced Imaging, Musculoskeletal, Sleep Medicine, Medical Specialty Drugs, and Genetic Testing. The change reduces prior authorization requirements to fewer than 20% of codes and all prior auth requests for these categories must now be submitted to BCBSMT instead of EviCore.
Action Required
By January 1, 2026: Billing team must update prior authorization submission workflows to send requests to BCBSMT instead of EviCore for Medicare Advantage members requiring Advanced Imaging, Musculoskeletal, Sleep Medicine, Medical Specialty Drugs, and Genetic Testing services. Update staff training materials and verify current prior authorization code requirements on BCBSMT website since fewer than 20% of codes will now require prior auth. Continue submitting Proton Beam Therapy requests to EviCore.