Provider Alerts

New fields added to e-referral inpatient authorizations

Use the Medical and Pharmacy Drug PA Portal to submit prior authorization requests for pharmacy benefit drugs

Aflibercept-yszy and Yimmugo to require prior authorization for Medicare Advantage members starting Oct. 27

Updated: New Provider Prior Authorizations website launches Oct. 22

Qivigy and Eydenzelt to require prior authorization for most commercial members starting Oct. 20

Enoby SC and Xtrenbo SC to require prior authorization for most commercial members starting Oct. 20

Changes to step therapy requirements for some medical benefit drugs for Medicare Advantage members

Training and FAQ now available for prior authorization process changes for in-lab sleep studies managed by Blue Cross and BCN

The average length of stay at most skilled nursing facilities has increased

We’re implementing point-of-sale edit for concurrent use of opioids, benzodiazepines beginning mid-October 2025

Update: Changes to prior authorization requirements for post-acute care services for Medicare Advantage members

e-referral system out of service for maintenance overnight October 18-19

Provider consultant inquiry mailbox temporarily closed, affects providers in East, Mid and Southeast regions

New BCN Advantage inpatient facility admissions peer-to-peer review process, starting Jan. 1

Update: Changes to preferred drug designations and other requirements for Medicare Advantage members, starting Nov. 1 and Jan. 1

We’ll use updated ABA supplemental policy starting Jan. 1

Changes to preferred drug designations under the medical benefit for most members, starting Jan. 1

Changes to our gold carding program for inpatient stays

Update: Fensolvi, Triptodur to have requirements for most commercial members, starting Jan. 1

Iluvien, Retisert to require prior authorization, step therapy requirements for most commercial members, starting Jan. 1

Update: Additional drugs to require prior authorization for Blue Cross commercial URMBT members starting Dec. 31

Beginning Jan. 1, Blue Cross commercial self-funded groups will move to Exclusive Specialty Network

Submit musculoskeletal prior authorization requests for FEP members to TurningPoint starting Jan. 1

Complete clinical documentation is required for Medicare Advantage post-acute care stay requests

Changes to prior authorization requirements for post-acute care and home health care services for Medicare Advantage member

Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting Sept. 28

We are changing how we manage Entyvio for most PPO, HMO commercial members, starting Jan. 1

We’re changing how we cover continuous glucose monitor products for commercial members, starting Jan. 1, 2026

Akynzeo, Cinvanti, Focinvez and Sustol to require prior authorization for most members starting Jan. 1

Aukelso and Bosaya to require prior authorization for most commercial members starting Sept. 29

Submit prior authorization requests for FEP members through the e-referral system starting Jan. 1

Updated Carelon clinical guidelines for various services

We’re no longer capturing clinical outcomes through Audaire Health for select medical benefit drugs for commercial members

Starting Jan. 1, 2026, we’ll change how we cover some drugs on our drug lists

Starting Jan. 1, we’ll change how we cover Rinvoq, Rinvoq LQ and Skyrizi on our Custom Select Drug List

Updated TurningPoint medical policies for musculoskeletal and pain management procedures

Training opportunities for in-lab sleep studies managed by Blue Cross and BCN

Learn more about prior authorization process changes for in-lab sleep studies for commercial members

e-referral system out of service for maintenance overnight September 20-21

Niktimvo to require prior authorization for Blue Cross commercial URMBT members starting Dec. 10

Leqembi IQLIK to require prior authorization for Medicare Advantage members starting Oct. 1

Bildyos SC and Bilprevda SC to require prior authorization for most commercial members starting Sept. 15

Update: Osenvelt and Stoboclo will be the preferred denosumab biosimilar products for most commercial members starting Dec. 15

New requirements for billing Part B compounded medications used in implantable infusion pumps starting Sept. 1

Update: Stoboclo and Osenvelt to be preferred denosumab products for Medicare Advantage members starting Dec. 15

Anktiva, Herceptin Hylecta and Onivyde will have step therapy requirements for most members starting Dec. 1

Datroway to require prior authorization for most members starting Dec. 1

Changes to prior authorization requirements for select services managed by BCN starting Aug. 24

Sept. 1 holiday closure: How to submit authorization requests for inpatient admissions

Papzimeos to require prior authorization for most commercial members starting Aug. 28

Additional drugs to require prior authorization for Blue Cross commercial URMBT members starting Nov. 12

Select the requesting provider when submitting prior authorization requests in the Medical and Pharmacy Drug PA Portal

e-referral system out of service for maintenance overnight August 16-17, 30-31

Additional drugs to require prior authorization for Medicare Advantage members starting Oct. 1

Starting Sept. 1, we’re replacing Humira with biosimilar drugs for most Medicare Advantage members

Changes to prior authorization requirements for select services managed by Blue Cross and BCN starting July 27

For medical procedures managed by BCN Utilization Management, submit prior authorization requests only for established procedure codes

Update: How to access the Medical and Pharmacy Drug PA Portal to submit prior authorization requests for commercial members

Bkemv will be the preferred eculizumab product for commercial members starting Oct. 12

EviCore category assignments and practitioner performance summaries for PTs and OTs will be available Aug. 1

e-referral system out of service for maintenance overnight July 19-20

Gammagard Liquid ERC to have requirements for most commercial members starting July 14

Additional drugs to have requirements for Blue Cross commercial URMBT members starting Oct. 8