Oct. 27, 2026

Blue Cross and Blue Shield of Texas Medicaid is updating its prior authorization processes effective January 1, 2027, to simplify administrative requirements and provide greater clarity regarding services that require prior authorization.

As part of this change, BCBSTX will discontinue issuing courtesy prior authorizations for services that do not require authorization under applicable benefit plans, regulatory requirements, contractual provisions, or clinical policies.

What This Means for Your Practice

Effective January 1, 2027:

• Services Not Requiring Prior Authorization: Providers should no longer submit courtesy prior authorization requests for services that do not require authorization. Instead, providers should render covered services, as appropriate, and submit claims through established billing processes.
• Services Requiring Prior Authorization: Providers must continue to obtain prior authorization for services where authorization is required under existing policies, benefit plans, or applicable requirements.
• Verification of Authorization Requirements: Providers should continue using existing BCBSTX authorization resources, provider portal tools, and established provider support channels to determine whether authorization is required before rendering services.

What Is Not Changing?

This update does not change existing prior authorization requirements, covered benefits, medical necessity criteria, claims submission guidelines, or applicable reimbursement policies.

Additionally, member rights, provider appeal rights, and all applicable regulatory and contractual requirements remain unchanged.

Frequently Asked Questions

What line of business does this apply? This is for BCBSTX Medicaid only.

Why is BCBSTX discontinuing courtesy prior authorizations?

Courtesy prior authorizations are sometimes requested for services that do not require authorization. Eliminating these unnecessary requests helps reduce administrative burden, streamline processes, and improve consistency in communicating authorization requirements.

How can I determine whether a service requires prior authorization?

Providers should continue to reference existing BCBSTX authorization resources and utilize established provider support channels to verify authorization requirements.

What if I need confirmation that prior authorization is not required?

Providers should use existing authorization verification resources and provider support channels. Additional guidance regarding documentation of services that do not require prior authorization will be communicated as available.

Will this change impact claims processing or reimbursement?

This change applies specifically to courtesy prior authorization requests. Claims must continue to be submitted and will be processed in accordance with applicable benefit plans, billing guidelines, and reimbursement policies. The absence of a prior authorization requirement does not guarantee payment.

Action Required

We encourage your practice to review its current authorization submission processes and ensure that requests are submitted only for services requiring prior authorization. Please share this information with staff responsible for scheduling, authorization submissions, and billing.

BCBSTX appreciates your continued partnership and commitment to providing quality care to our members. Thank you for your cooperation as we work to simplify administrative processes and improve the provider experience.

N. Angela Moemeka, MD, MBA

Chief Medical Officer, Government Programs & Population Health 

Blue Cross and Blue Shield of Texas