April 3, 2025
We’re changing prior authorization requirements for members of Medicare Advantage to reflect new, replaced or removed codes. Changes are based on updates from utilization management or the American Medical Association.
Changes Include:
- July 1, 2025 – Addition of specialty drug codes to be reviewed by eviCore
- July 1, 2025 – Addition of lab management codes to be reviewed by eviCore
For more information, refer to our prior authorization lists.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
If prior authorization is required, services performed without prior authorization or that don’t meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
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 Blue Cross and Blue Shield of Oklahoma.
eviCore healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSOK.
BCBSOK makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.