Provider Alerts
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October 2026
- Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Oct. 25
- Provider satisfaction surveys coming soon for Medicare Advantage post-acute care and home healthcare prior authorization programs
- e-referral system out of service for maintenance Oct. 17-18
- Questionnaires not opening for BCN commercial, BCN Advantage bundled appeal requests due to system issue
- Discharge planning evaluations required for Medicare Advantage inpatient authorization requests, starting Nov. 9
- We're adding requirements for Degevma SC for most members starting Oct. 12 and Jan. 1
- Updaate: Most Blue Cross and BCN commercial members must obtain continuous glucose monitor products through an exclusive provider starting Jan. 1
- Save time when requesting prior authorization for medical benefit drugs for Blue Cross and BCN commercial members
- Changes to preferred drug designations for Medicare Advantage members starting Jan. 1
- Starting Jan. 1, 2027, there'll be changes to how certain medications are covered on the Premium Drug List
- Update: Additional drugs to require prior authorization for most members through the Oncology Value Management program starting Jan. 1
September 2026
- Update: Enoby and Xtrenbo will be the preferred denosumab biosimilar products for Medicare Advantage members starting Oct. 1
- Starting Jan. 1, 2027, we’ll change how we cover certain drugs on our drug lists
- Use established HCPCS and CPT codes when submitting prior authorization requests for BCN members
- Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Sept. 27
- Update: Oncology gene and cell therapy drugs to be managed through the Oncology Value Management program starting Jan. 1
- Isembyld IV and Fayuvi IV to require prior authorization for most members starting Sept. 28 and Oct. 1
- Guidelines for submitting clinical information for medical necessity review of inpatient medical or surgical admissions
- We're making changes to preferred drug designations under medical benefits for most members, starting Jan. 1
- e-referral system out of service for maintenance Sept. 19-20
- Updated TurningPoint medical policies for musculoskeletal and pain management procedures
- Update admission and discharge dates on authorizations for Medicare Advantage SNF, LTACH and IRF stays before submitting claims
- HelpScript enrollment service for manufacturer copay assistance will include Blue Cross, BCN commercial members who receive treatments from facility providers
- Zanvastro IV to require prior authorization for most members starting Sept. 21 and Oct. 1
- MESSA members will have requirements under the Oncology Value Management program starting Jan. 1
- Referrals to home healthcare for Medicare Advantage members: Grace period extended through Dec. 31 for acute care providers
- Update: Some BCN members displaying as inactive in error
- Retracted: Enoby and Xtrenbo will be the preferred denosumab biosimilar products for Medicare Advantage members starting Oct. 1
- Enoby and Xtrenbo will be the preferred denosumab biosimilar products for most commercial members starting Jan. 1
August 2026
- Sept. 7 holiday closure: How to submit authorization requests for inpatient admissions
- Ponlimsi to require prior authorization for Medicare Advantage members starting Oct. 1
- Genglycos IV and Pasatru IV to require prior authorization for most members starting Aug. 31 and Oct. 1
- Transfer Medicare Advantage members to post-acute care facilities immediately after appeals are approved
- Tudriqev to require prior authorization for most members starting Aug. 24 and Sept. 1
- e-referral system out of service for maintenance August 22-23
- Submit additional clinical documentation to support LTACH payment methodology for Medicare Advantage members
- How we communicate changes to questionnaires that open in the e-referral system
- Additional medical benefit drugs to require prior authorization for Blue Cross commercial URMBT members starting Nov. 4
- Issue Resolved: Requesting authorization if e-referral system shows an incorrect message about global referrals for BCN commercial members
July 2026
- Save time when requesting prior authorization for non-coronary vascular stent procedures
- New e-referral message will help you save time with some outpatient authorization requests for BCN members
- Change to breast reduction questionnaire for BCN commercial starting July 26
- Release schedule for EviCore category assignments and practitioner performance summaries for PTs and OTs
- e-referral system out of service for maintenance July 18-19
- Blenrep to require prior authorization for Blue Cross commercial URMBT members starting Oct. 7
- Tregzi to require prior authorization for most members starting July 13 and Aug. 3
- Lumvoa IV to require prior authorization for most members starting July 13 and Aug. 3
- Starting July 1, your patients may be eligible for GLP-1 weight loss coverage through Medicare GLP-1 Bridge
- Respond to calls and inquiries from HelpScript
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