Dec. 23, 2025 (Updated Jan. 6, 2026)
We’re making changes to the prior authorization process for members with Medicare Advantage.
What’s changing: Effective Jan. 1, 2026, Blue Cross and Blue Shield of Texas will review prior authorization requests for certain care categories that were previously reviewed by EviCore healthcare.
Effective for dates of service on or after Jan. 1, 2026, prior authorization requests for our Medicare Advantage members should be submitted to BCBSTX for the following care categories:
- Advanced imaging
- Musculoskeletal
- Sleep
- Medical specialty drugs
- Genetic testing
Our prior authorization page will be updated shortly to reflect changes effective Jan. 1, 2026. Review our FAQ for more information.
Remember to check eligibility and benefits through Availity® Essentials or your preferred vendor portal. This step helps confirm if prior authorization is required for a specific service and member. You’ll also be directed to the appropriate utilization management vendor, if applicable, to submit your request for review.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. EviCore healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSTX.